Provider Demographics
NPI:1891418125
Name:CLADIS, JESSICA (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CLADIS
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 RYAN DR
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4659
Mailing Address - Country:US
Mailing Address - Phone:815-474-0700
Mailing Address - Fax:
Practice Address - Street 1:3465 RYAN DR
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-4659
Practice Address - Country:US
Practice Address - Phone:815-474-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008566133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist