Organization
WILD TABLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INGRID CLARK MS, RD, LDN (REGISTERED DIETITIAN)
(608) 438-1612
Entity
Organization
Contact information
Practice address
740 N OGDEN AVE APT 4, CHICAGO, IL 60642-7063
(608) 438-1612
Mailing address
1842 N ALBANY AVE, CHICAGO, IL 60647-5073
(608) 438-1612
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
04/01/2025
Last updated
04/01/2025
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