Individual
JAMIE RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN, CNSC
Contact information
Practice address
840 S WOOD ST FL 12, CHICAGO, IL 60612-4325
(312) 996-9283
(312) 355-0732
Mailing address
1553 N WELLS ST APT 504, CHICAGO, IL 60610-0918
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
164006949
IL
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
164006949
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164006949
DIETITIAN LICENSURE NUMBER
IL
Enumeration date
02/01/2021
Last updated
02/01/2021
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