Healthcare Provider Details

I. General information

NPI: 1194031146
Provider Name (Legal Business Name): CHRISTINE ANN ROSS RD, LDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE ANN MORRIS RD, LDN, CDE

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9977 WOODS DR
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

2650 RIDGE AVE
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-8508
  • Fax: 847-663-8515
Mailing address:
  • Phone: 847-982-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number164.004793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: