Provider Demographics
NPI:1285616326
Name:MASLANKA, MARY THERESE (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESE
Last Name:MASLANKA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 N ONEIDA CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1686
Mailing Address - Country:US
Mailing Address - Phone:847-297-8372
Mailing Address - Fax:847-813-6082
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-9520
Practice Address - Fax:773-631-9532
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI202099Medicare ID - Type Unspecified