Provider Demographics
NPI:1376869883
Name:NUTRITION COUNSELING SERVICES
Entity Type:Organization
Organization Name:NUTRITION COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIMBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CDN
Authorized Official - Phone:312-235-0050
Mailing Address - Street 1:410 SOUTH MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 631
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1308
Mailing Address - Country:US
Mailing Address - Phone:312-235-0050
Mailing Address - Fax:
Practice Address - Street 1:410 S MICHIGAN AVE
Practice Address - Street 2:STE 631
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1308
Practice Address - Country:US
Practice Address - Phone:312-235-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3122350050Medicaid