Individual
ANNIE LAURIE WIDLICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1470
(773) 702-1000
Mailing address
541 W OAKDALE AVE APT 509, CHICAGO, IL 60657
(773) 857-3578
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
IL
Other
Enumeration date
07/20/2006
Last updated
07/08/2007
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