Provider Demographics
NPI:1679990196
Name:MALCHOW, JENNIFER (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MALCHOW
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E HAWTHORN PKWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1463
Mailing Address - Country:US
Mailing Address - Phone:847-868-3435
Mailing Address - Fax:
Practice Address - Street 1:999 N PLAZA DR
Practice Address - Street 2:SUITE 115
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-6022
Practice Address - Country:US
Practice Address - Phone:847-868-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004616133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered