Provider Demographics
NPI:1477682854
Name:MCCABE, JENNIFER LYNN (RD, LD, CLC, CD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCCABE
Suffix:
Gender:F
Credentials:RD, LD, CLC, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 OSTEEN LN
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-5007
Mailing Address - Country:US
Mailing Address - Phone:217-280-0220
Mailing Address - Fax:217-483-6891
Practice Address - Street 1:306 OSTEEN LN
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-5007
Practice Address - Country:US
Practice Address - Phone:217-280-0220
Practice Address - Fax:217-483-6891
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric