Healthcare Provider Details

I. General information

NPI: 1003746033
Provider Name (Legal Business Name): JILL ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 BRANDON RD
GLENVIEW IL
60025-2337
US

IV. Provider business mailing address

1410 BRANDON RD
GLENVIEW IL
60025-2337
US

V. Phone/Fax

Practice location:
  • Phone: 773-343-3363
  • Fax:
Mailing address:
  • Phone: 773-343-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164023944
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: