Healthcare Provider Details

I. General information

NPI: 1669647467
Provider Name (Legal Business Name): LISA M.L. BABBO RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA M. LEOPOLDO RD, LDN

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE IMMC-DEPARTMENT OF FOOD AND NUTRITION SERVICES
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

836 W WELLINGTON AVE IMMC-DEPARTMENT OF FOOD AND NUTRITION SERVICES
CHICAGO IL
60657-5147
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-5822
  • Fax: 773-296-5914
Mailing address:
  • Phone: 773-296-5822
  • Fax: 773-296-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.002832
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: