Provider Demographics
NPI:1639754609
Name:MARTIN, JENNIFER R (MS, RD, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 W BELMONT AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6405
Mailing Address - Country:US
Mailing Address - Phone:224-279-5991
Mailing Address - Fax:
Practice Address - Street 1:355 E GRAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5389
Practice Address - Country:US
Practice Address - Phone:224-279-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management