Provider Demographics
NPI:1275137952
Name:SPIWAK, ABBIE CLAIRE (RD)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:CLAIRE
Last Name:SPIWAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020B IOWA RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5517
Mailing Address - Country:US
Mailing Address - Phone:815-355-6298
Mailing Address - Fax:
Practice Address - Street 1:2020B IOWA RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5517
Practice Address - Country:US
Practice Address - Phone:815-355-6298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008163133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered