MEDICARE: DR. HONORA SIMON PH.D, RD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	133N00000X	Nutritionist	IL
2	103TH0004X	Health Psychologist	IL
3	103TB0200X	Cognitive & Behavioral Psychologist	IL
4	103TC0700X	Clinical Psychologist	IL
5	133V00000X	Registered Dietitian	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1672418	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1902022866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HONORA SIMON PH.D, RD

Provider Business Mailing Address
First Line	:	910 S MICHIGAN AVE
Second Line	:	#1310
City	:	CHICAGO
State	:	IL
Zip	:	60605-2356
Country	:	US
Telephone Number	:	312-939-9594
Fax Number	:	312-939-9594

Provider Business Practice Location Address
First Line	:	910 S MICHIGAN AVE
Second Line	:	#1310
City	:	CHICAGO
State	:	IL
Zip	:	60605-2356
Country	:	US
Telephone Number	:	312-939-9594
Fax Number	:	312-939-9594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/11/2025

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