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KRISTIAN TAYLOR JOHANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RD

Contact information

Practice address
1114 LAKE ST, OAK PARK, IL 60301-1002
(708) 383-1114
(312) 648-0155
Mailing address
1114 LAKE ST, OAK PARK, IL 60301-1002
(708) 383-1114
(312) 648-0155

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164008224
IL

Other

Enumeration date
07/13/2020
Last updated
08/08/2022
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