Provider Demographics
NPI:1720312267
Name:SCHANTZ, BROOKE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SCHANTZ
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 WAUKEGAN ROAD,
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3070
Mailing Address - Country:US
Mailing Address - Phone:877-486-4140
Mailing Address - Fax:
Practice Address - Street 1:1308 WAUKEGAN ROAD,
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3070
Practice Address - Country:US
Practice Address - Phone:877-486-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005121133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered