Provider Demographics
NPI:1760894414
Name:ALLENDER, JESSICA CORAL (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CORAL
Last Name:ALLENDER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 S UNIVERSITY AVE
Mailing Address - Street 2:APT 1S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-3182
Mailing Address - Country:US
Mailing Address - Phone:773-710-2237
Mailing Address - Fax:773-966-4119
Practice Address - Street 1:6116 S UNIVERSITY AVE
Practice Address - Street 2:APT 1S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-3182
Practice Address - Country:US
Practice Address - Phone:773-710-2237
Practice Address - Fax:773-966-4119
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004016133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered