Individual
JESSICA SHAPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
710 N FAIRBANKS CT, CHICAGO, IL 60611-3013
(312) 926-4082
Mailing address
710 N FAIRBANKS CT, CHICAGO, IL 60611-3013
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164006297
IL
Other
Enumeration date
07/10/2015
Last updated
07/10/2015
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