Provider Demographics
NPI:1598982639
Name:WELSTEAD, LORI ANN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:WELSTEAD
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC 4080
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-0019
Mailing Address - Fax:773-834-4037
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 4080
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-0019
Practice Address - Fax:773-834-4037
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004199133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered