Healthcare Provider Details

I. General information

NPI: 1750703393
Provider Name (Legal Business Name): AMY WITT HOFFBERG RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CLAVEY LN
HIGHLAND PARK IL
60035-4533
US

IV. Provider business mailing address

550 CLAVEY LN
HIGHLAND PARK IL
60035-4533
US

V. Phone/Fax

Practice location:
  • Phone: 708-307-7946
  • Fax:
Mailing address:
  • Phone: 708-307-7946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.006107
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: