Provider Demographics
NPI:1740475243
Name:MINSKY, BONNIE CAROL (LDN, MPH)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:CAROL
Last Name:MINSKY
Suffix:
Gender:F
Credentials:LDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 LAKE COOK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1447
Mailing Address - Country:US
Mailing Address - Phone:847-498-3422
Mailing Address - Fax:847-509-9069
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1447
Practice Address - Country:US
Practice Address - Phone:847-498-3422
Practice Address - Fax:847-509-9069
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist