Individual
MISS JENNIFER LYNN GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,LDN,CDE.
Contact information
Practice address
2233 W DIVISION ST, CHICAGO, IL 60622-8151
(312) 770-2275
(312) 633-5882
Mailing address
2233 W DIVISION ST, CHICAGO, IL 60622-8151
(312) 770-2275
(312) 633-5882
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
164002821
IL
Other
Enumeration date
08/23/2007
Last updated
10/05/2017
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