Provider Demographics
NPI:1063790228
Name:STECKLER, JAMIE A (RD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:STECKLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 W WAVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3713
Mailing Address - Country:US
Mailing Address - Phone:312-343-5459
Mailing Address - Fax:
Practice Address - Street 1:1418 W WAVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3713
Practice Address - Country:US
Practice Address - Phone:312-343-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004645133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered