Provider Demographics
NPI:1043458938
Name:SPILOTRO, JENNIFER MARIE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:SPILOTRO
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 N ORCHARD ST
Mailing Address - Street 2:#B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7156
Mailing Address - Country:US
Mailing Address - Phone:847-373-7891
Mailing Address - Fax:773-539-0039
Practice Address - Street 1:5061 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2706
Practice Address - Country:US
Practice Address - Phone:773-539-8181
Practice Address - Fax:773-539-0039
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004632133N00000X, 133V00000X, 261QR1100X, 283Q00000X, 310400000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No283Q00000XHospitalsPsychiatric Hospital
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility