Provider Demographics
NPI:1144013145
Name:O'CONNELL, TARA KELSI (RD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:KELSI
Last Name:O'CONNELL
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 1:560 KNOLLS ST W
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2993
Mailing Address - Country:US
Mailing Address - Phone:630-770-6384
Mailing Address - Fax:
Practice Address - Street 1:560 KNOLLS ST W
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2993
Practice Address - Country:US
Practice Address - Phone:630-770-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered