Individual
MRS. AMANDA MARIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(312) 227-4133
Mailing address
520 N OAKLEY BLVD APT 3S, CHICAGO, IL 60612-1427
(708) 560-6265
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.005907
IL
Other
Enumeration date
08/24/2020
Last updated
08/24/2020
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