Provider Demographics
NPI:1710314927
Name:PATT, PAMELA LYNN (RD, CSP, LD, CNSC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:PATT
Suffix:
Gender:F
Credentials:RD, CSP, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3351
Mailing Address - Country:US
Mailing Address - Phone:773-385-5436
Mailing Address - Fax:
Practice Address - Street 1:2211 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3351
Practice Address - Country:US
Practice Address - Phone:773-385-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.000490133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric