Provider Demographics
NPI:1780223461
Name:MAGNUSON, REBECCA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 N MICHIGAN AVE STE 1925
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5422
Mailing Address - Country:US
Mailing Address - Phone:312-283-2650
Mailing Address - Fax:312-888-9937
Practice Address - Street 1:737 N MICHIGAN AVE STE 1925
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5422
Practice Address - Country:US
Practice Address - Phone:312-283-2650
Practice Address - Fax:312-888-9937
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007268133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered