Healthcare Provider Details

I. General information

NPI: 1710241872
Provider Name (Legal Business Name): ILLINOIS DIETITIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LAKE ST STE 220
OAK PARK IL
60301-1411
US

IV. Provider business mailing address

715 LAKE ST STE 220
OAK PARK IL
60301-1411
US

V. Phone/Fax

Practice location:
  • Phone: 708-285-1347
  • Fax: 708-356-6611
Mailing address:
  • Phone: 708-285-1347
  • Fax: 708-356-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. EILEEN HOURIHAN MCCARTHY
Title or Position: REGISTERED DIETITIAN
Credential: MFN, RDN, LDN, CPT
Phone: 708-285-1347