Provider Demographics
NPI:1770594673
Name:KLIMCZAK, KAREN MELISSA (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MELISSA
Last Name:KLIMCZAK
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5061 N PULASKI RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2706
Mailing Address - Country:US
Mailing Address - Phone:773-539-8181
Mailing Address - Fax:773-539-0039
Practice Address - Street 1:5061 N PULASKI RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2706
Practice Address - Country:US
Practice Address - Phone:773-539-8181
Practice Address - Fax:773-539-0039
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004727133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered