Individual
LAURA ANN JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
1801 W WINDSOR RD, CHAMPAIGN, IL 61822-6217
(217) 366-8144
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3981
(217) 366-8130
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.004493
IL
Other
Enumeration date
06/27/2007
Last updated
05/29/2024
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