Provider Demographics
NPI:1851803324
Name:STARR, MEREDITH SHANNON (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:SHANNON
Last Name:STARR
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6184
Mailing Address - Country:US
Mailing Address - Phone:630-347-6524
Mailing Address - Fax:
Practice Address - Street 1:150 E HURON ST STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2949
Practice Address - Country:US
Practice Address - Phone:312-964-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86033903133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered