Provider Demographics
NPI:1578620753
Name:SOLOMON, MARLA COHN (RD, LD/N, CDE)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:COHN
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:RD, LD/N, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 ORCHARD LANE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4145
Mailing Address - Country:US
Mailing Address - Phone:847-501-5170
Mailing Address - Fax:847-784-8392
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-1795
Practice Address - Fax:312-996-8218
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-000305133NN1002X
IL164000305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164-000305OtherIL STATE LIC