Individual
STEPHANIE FAWBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 E LIBERTY ST, 803, LOUISVILLE, KY 40202-1530
(502) 587-4576
Mailing address
850 W IRVING PARK RD, CHICAGO, IL 60613-3077
(773) 975-6775
(773) 975-3289
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164007358
IL
Other
Enumeration date
10/01/2013
Last updated
05/24/2018
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