Provider Demographics
NPI:1144278557
Name:HELLER, MARLA CRILL (RD)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:CRILL
Last Name:HELLER
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 1:3001 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-2833
Mailing Address - Country:US
Mailing Address - Phone:847-480-7698
Mailing Address - Fax:847-681-9748
Practice Address - Street 1:3001 6TH ST
Practice Address - Street 2:A
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:847-480-7698
Practice Address - Fax:847-681-9748
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12402811133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered