Provider Demographics
NPI:1558796441
Name:EARLY, VALERIE ANN (RD, LDN, RPHT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:EARLY
Suffix:
Gender:F
Credentials:RD, LDN, RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3010
Mailing Address - Country:US
Mailing Address - Phone:847-985-1200
Mailing Address - Fax:
Practice Address - Street 1:1443 W SCHAUMBURG RD
Practice Address - Street 2:STE 22
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-4065
Practice Address - Country:US
Practice Address - Phone:847-985-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003605133V00000X
IL049.158529183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No183700000XPharmacy Service ProvidersPharmacy Technician