Healthcare Provider Details

I. General information

NPI: 1033596424
Provider Name (Legal Business Name): COURTNEY KATHLEEN SHORTRIDGE MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 FREEMAN RD
HOFFMAN ESTATES IL
60192-1624
US

IV. Provider business mailing address

1625 FREEMAN RD
HOFFMAN ESTATES IL
60192-1624
US

V. Phone/Fax

Practice location:
  • Phone: 708-743-9743
  • Fax:
Mailing address:
  • Phone: 708-743-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86037692
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: