Provider Demographics
NPI:1932111267
Name:BYCZEK, KELLY S (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:BYCZEK
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:S
Other - Last Name:CONTOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2705
Mailing Address - Country:US
Mailing Address - Phone:906-225-3221
Mailing Address - Fax:906-225-7427
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-225-3221
Practice Address - Fax:906-225-7427
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1670-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered