Provider Demographics
NPI:1013771070
Name:PIEPER, SKYLAR J
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:J
Last Name:PIEPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N RACINE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5572
Mailing Address - Country:US
Mailing Address - Phone:217-801-5266
Mailing Address - Fax:
Practice Address - Street 1:613 N RACINE AVE APT 4
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5572
Practice Address - Country:US
Practice Address - Phone:217-801-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164009421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered