Provider Demographics
NPI:1285964692
Name:BITEL-KOSKELA, LESLI SUSAN (RD, LDN)
Entity type:Individual
Prefix:
First Name:LESLI
Middle Name:SUSAN
Last Name:BITEL-KOSKELA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 RFD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9612
Mailing Address - Country:US
Mailing Address - Phone:847-821-8087
Mailing Address - Fax:
Practice Address - Street 1:3118 RFD
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-9612
Practice Address - Country:US
Practice Address - Phone:847-821-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164002218133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered