Provider Demographics
NPI:1326719113
Name:AGUIRRIE, JENNIFER ALEXIS
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALEXIS
Last Name:AGUIRRIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 W DIVERSEY PKWY APT 309
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-9386
Mailing Address - Country:US
Mailing Address - Phone:512-567-2333
Mailing Address - Fax:
Practice Address - Street 1:1735 W DIVERSEY PKWY APT 309
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-9386
Practice Address - Country:US
Practice Address - Phone:512-567-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered