Provider Demographics
NPI:1568402287
Name:STEWART, DOROTHY M (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2491 STONEGATE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6403
Mailing Address - Country:US
Mailing Address - Phone:847-888-8177
Mailing Address - Fax:847-888-8178
Practice Address - Street 1:1275 DAVIS RD
Practice Address - Street 2:SUITE 121
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1304
Practice Address - Country:US
Practice Address - Phone:847-888-8177
Practice Address - Fax:847-888-8178
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered