Provider Demographics
NPI:1669647467
Name:BABBO, LISA ML (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ML
Last Name:BABBO
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:LEOPOLDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:836 W WELLINGTON AVE
Mailing Address - Street 2:IMMC-DEPARTMENT OF FOOD AND NUTRITION SERVICES
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5147
Mailing Address - Country:US
Mailing Address - Phone:773-296-5822
Mailing Address - Fax:773-296-5914
Practice Address - Street 1:836 W WELLINGTON AVE
Practice Address - Street 2:IMMC-DEPARTMENT OF FOOD AND NUTRITION SERVICES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5147
Practice Address - Country:US
Practice Address - Phone:773-296-5822
Practice Address - Fax:773-296-5914
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002832133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered