Provider Demographics
NPI:1750622189
Name:YUDYS, LAURA H (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:YUDYS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:B
Other - Last Name:HORNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:710 N FAIRBANKS CT
Mailing Address - Street 2:7-121
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3013
Mailing Address - Country:US
Mailing Address - Phone:312-926-7437
Mailing Address - Fax:
Practice Address - Street 1:710 N FAIRBANKS CT
Practice Address - Street 2:7-121
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3013
Practice Address - Country:US
Practice Address - Phone:312-926-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005467133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered