Healthcare Provider Details

I. General information

NPI: 1760652317
Provider Name (Legal Business Name): LAURIE MARIE SLAVIN MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

1301 PIN OAK CT
WHEATON IL
60187-6024
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5753
  • Fax:
Mailing address:
  • Phone: 630-668-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: