Most Relevant Information
Provider Data
| NPI Number: | 1003460882 |
| Provider Name: | KYNDAL LYN HETTICH RD, CSP, CD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/30/2019 |
| Last Updated: | 07/30/2019 |
Provider Practice Location
9000 W WISCONSIN AVE
MILWAUKEE
WI
532264874
Practice Location Phone/Fax
| Phone: | 4142665938 |
| Fax: |
Provider Mailing Location
1626 N PROSPECT AVE APT 706
MILWAUKEE
WI
532022421
Provider Mailing Phone/Fax
| Phone: | 4146886339 |
| Fax: |