Provider Demographics
NPI:1134463136
Name:SHUDNOW, ALLISON BROOKE (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:BROOKE
Last Name:SHUDNOW
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W WASHINGTON ST
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2801
Mailing Address - Country:US
Mailing Address - Phone:847-721-8030
Mailing Address - Fax:
Practice Address - Street 1:77 W WASHINGTON ST
Practice Address - Street 2:SUITE 1620
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2801
Practice Address - Country:US
Practice Address - Phone:847-721-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004286133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered