Provider Demographics
NPI:1851182471
Name:COPELAND, REBECCA (RD, LDN, CDCES)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:RD, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W WAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1843
Mailing Address - Country:US
Mailing Address - Phone:309-229-4848
Mailing Address - Fax:
Practice Address - Street 1:223 W WAGLER ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1843
Practice Address - Country:US
Practice Address - Phone:309-229-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty