MEDICARE: NUTRITION COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	164004712	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376869883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	410 SOUTH MICHIGAN AVENUE
Second Line	:	SUITE 631
City	:	CHICAGO
State	:	IL
Zip	:	60605-1308
Country	:	US
Telephone Number	:	312-235-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 S MICHIGAN AVE
Second Line	:	STE 631
City	:	CHICAGO
State	:	IL
Zip	:	60605-1308
Country	:	US
Telephone Number	:	312-235-0050
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER A VIMBOR
Credential	:	MS, RD, LDN, CDN
Telephone Number	:	312-235-0050

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	04/09/2010

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Directions to “NUTRITION COUNSELING SERVICES ” Practice Location

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