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DR. RICHENEL SAMUEL ELLECOM PSY.D; DR.P.H NPI 1063406569


NPI Information

NPI: 1063406569
Provider Name: DR. RICHENEL SAMUEL ELLECOM, PSY.D; DR.P.H
Classification: Dietitian, Registered - 133V00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
621 PLAINFIELD RD
SUITE 110
WILLOW BROOK, IL
ZIP 60527
Phone: (630) 654-1377
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DR. Richenel Samuel Ellecom, PSY.D; DR.P.H is a dietitian registered in Willow Brook, IL. The provider is a Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation. DR. Richenel Samuel Ellecom, PSY.D; DR.P.H NPI is 1063406569. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

621 PLAINFIELD RD
SUITE 110
WILLOW BROOK, IL
ZIP 60527-343
Phone: (630) 654-1377
Fax: (630) 654-2575

The NPI 1063406569 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 9/12/2005 and was last updated on 10/27/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103G00000XClinical Neuropsychologist71-5240ILLINOISNo
2103G00000XClinical Neuropsychologist20040961AINDIANANo
3133V00000XDietitian, Registered164-2611ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1200909210AMEDICAIDINDIANA
2200078600MEDICAIDINDIANA
3877640AMEDICARE PININDIANA
4392810MEDICARE PINILLINOIS
5409580AMEDICARE PININDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.