Healthcare Provider Details

I. General information

NPI: 1588501779
Provider Name (Legal Business Name): CHLOE NICOLE VERHAGEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 LONGFELLOW DR
WHEATON IL
60189-7477
US

IV. Provider business mailing address

169 LONGFELLOW DR
WHEATON IL
60189-7477
US

V. Phone/Fax

Practice location:
  • Phone: 708-261-1354
  • Fax:
Mailing address:
  • Phone: 708-261-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86297008
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: