Provider Demographics
NPI:1659502284
Name:ANNE C KOZEK, RD,MS,LDN YOUR CREATIVE NUTRITION RESOURCE
Entity Type:Organization
Organization Name:ANNE C KOZEK, RD,MS,LDN YOUR CREATIVE NUTRITION RESOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:KOZEK
Authorized Official - Suffix:
Authorized Official - Credentials:RD,MS,LDN
Authorized Official - Phone:773-429-9614
Mailing Address - Street 1:2738 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1832
Mailing Address - Country:US
Mailing Address - Phone:773-429-9614
Mailing Address - Fax:
Practice Address - Street 1:2738 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1832
Practice Address - Country:US
Practice Address - Phone:773-429-9614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001499133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty