Provider Demographics
NPI:1134505928
Name:LANGFORD, REBEKAH LYNN (RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNN
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6238 26TH ST UNIT 409
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-5407
Mailing Address - Country:US
Mailing Address - Phone:312-581-6993
Mailing Address - Fax:
Practice Address - Street 1:6238 26TH ST UNIT 409
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-5407
Practice Address - Country:US
Practice Address - Phone:312-581-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered