Provider Demographics
NPI:1881016293
Name:SCHWARTZ, JAMIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SCHWARTZ
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 1:2026 W CHARLESTON ST
Mailing Address - Street 2:#GDN
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2026 W CHARLESTON ST
Practice Address - Street 2:#GDN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4519
Practice Address - Country:US
Practice Address - Phone:214-289-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered