Provider Demographics
NPI:1609648187
Name:THE FAMILY DIETITIANS
Entity Type:Organization
Organization Name:THE FAMILY DIETITIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:VLAZNY
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:773-875-5683
Mailing Address - Street 1:5600 WOLF RD STE 135
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2201
Mailing Address - Country:US
Mailing Address - Phone:773-875-5683
Mailing Address - Fax:708-274-1163
Practice Address - Street 1:5600 WOLF RD STE 135
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-2201
Practice Address - Country:US
Practice Address - Phone:773-875-5683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1659760536Medicaid