Provider Demographics
NPI:1528848496
Name:MITCHELL, BRIDGET (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37W628 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6225
Mailing Address - Country:US
Mailing Address - Phone:630-849-8145
Mailing Address - Fax:
Practice Address - Street 1:37W628 EMERALD CT
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6225
Practice Address - Country:US
Practice Address - Phone:630-849-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered