Provider Demographics
NPI:1720407653
Name:WOLFSON, ILANA (RD,LD)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23250 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5470
Mailing Address - Country:US
Mailing Address - Phone:216-464-4243
Mailing Address - Fax:216-595-8210
Practice Address - Street 1:23250 CHAGRIN BLVD
Practice Address - Street 2:SUITE 425
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5470
Practice Address - Country:US
Practice Address - Phone:216-464-4243
Practice Address - Fax:216-595-8210
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
866261133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist