Provider Demographics
NPI:1205357282
Name:SOUTHWOOD, COURTNEY RULYNN (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RULYNN
Last Name:SOUTHWOOD
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6145
Mailing Address - Country:US
Mailing Address - Phone:630-986-2800
Mailing Address - Fax:
Practice Address - Street 1:460 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6145
Practice Address - Country:US
Practice Address - Phone:630-986-2800
Practice Address - Fax:630-986-2440
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005319133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered