Provider Demographics
NPI:1376256248
Name:BROWNSTEIN, JESSIE (RD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:BROWNSTEIN
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 1:4004 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1942
Mailing Address - Country:US
Mailing Address - Phone:561-632-7586
Mailing Address - Fax:
Practice Address - Street 1:4004 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1942
Practice Address - Country:US
Practice Address - Phone:561-632-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008752133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered