Individual
MRS. SHIRLEY JEAN POOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD CSP LDN
Contact information
Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(815) 489-4667
(815) 964-5404
Mailing address
11249 CHANEY DR, MACHESNEY PARK, IL 61115-7438
(815) 489-4667
(815) 967-5404
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
—
IL
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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