Provider Demographics
NPI:1316730906
Name:CZYZEWSKI, OLA (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:OLA
Middle Name:
Last Name:CZYZEWSKI
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 KELBURN RD APT 212
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4367
Mailing Address - Country:US
Mailing Address - Phone:847-975-8943
Mailing Address - Fax:
Practice Address - Street 1:912 W DAKIN ST APT 206
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5021
Practice Address - Country:US
Practice Address - Phone:847-975-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.012079133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered