Provider Demographics
NPI:1306381066
Name:ROBESON, LISA L (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:ROBESON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5928 FAIMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:307-349-7350
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2914
Practice Address - Country:US
Practice Address - Phone:630-323-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006805133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered