Provider Demographics
NPI:1902384332
Name:KALINICH, ALICIA (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:KALINICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 W WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3316
Mailing Address - Country:US
Mailing Address - Phone:630-670-1655
Mailing Address - Fax:
Practice Address - Street 1:257 W WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3316
Practice Address - Country:US
Practice Address - Phone:630-670-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164001591133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered