Provider Demographics
NPI:1811552904
Name:CHUDZINSKI, VALARIE LYNN (RDN LDN)
Entity Type:Individual
Prefix:
First Name:VALARIE
Middle Name:LYNN
Last Name:CHUDZINSKI
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 1:713 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-3385
Mailing Address - Country:US
Mailing Address - Phone:317-407-3990
Mailing Address - Fax:
Practice Address - Street 1:713 DORAL DR
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-3385
Practice Address - Country:US
Practice Address - Phone:317-407-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004735133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered