Provider Demographics
NPI:1326773037
Name:VISION NUTRITION COUNSELING, LLC
Entity Type:Organization
Organization Name:VISION NUTRITION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:615-484-5278
Mailing Address - Street 1:4247 N AVERS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1644 N HONORE ST STE 106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1375
Practice Address - Country:US
Practice Address - Phone:615-484-5278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1740710060OtherBLUE CROSS BLUE SHIELD, UNITED HEALTHCARE