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General NPI Number Information
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NPI Number | 1871103341
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Entity Type | Individual
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Provider Name | CAMILLE WACHHOLZ
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Gender | Female
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Dates
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Enumeration Date | 08/08/2020
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 1401 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1858
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Country | US
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Telephone | 773-257-4324
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Fax |
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Provider Business Mailing Address
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Address Line | 4107 N DAMEN AVE APT 33
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City | CHICAGO
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State | IL
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Zip | 60618-3258
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Country | US
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Telephone | 906-399-8809
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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