Provider Demographics
NPI:1346097631
Name:HELLER, RENEE KAYLA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:KAYLA
Last Name:HELLER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 HILLDALE LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-7016
Mailing Address - Country:US
Mailing Address - Phone:224-343-3927
Mailing Address - Fax:
Practice Address - Street 1:4945 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3825
Practice Address - Country:US
Practice Address - Phone:708-244-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86296613133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered