Provider Demographics
NPI:1124185392
Name:KOLISH, JUDITH ELIZABETH (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELIZABETH
Last Name:KOLISH
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 W LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8038
Mailing Address - Country:US
Mailing Address - Phone:847-529-6796
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD RD. SUITE 6
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:847-529-6796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164-002845OtherIL STATE LIC