=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558513358
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOELLEN KAUFMAN M.S.,L.D.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2008
-----------------------------------------------------
Last Update Date | 10/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 SKOKIE BLVD SUITE 206
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-272-8500
-----------------------------------------------------
Fax | 847-272-8501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 SKOKIE BLVD SUITE 206
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-272-8500
-----------------------------------------------------
Fax | 847-272-8501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | 164.004023
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------