Provider Demographics
NPI:1487092789
Name:HENDERSON, CRISTIN N (MS, RD)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:N
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 S MICHIGAN AVE
Mailing Address - Street 2:UNIT 1301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2776
Mailing Address - Country:US
Mailing Address - Phone:847-804-9602
Mailing Address - Fax:
Practice Address - Street 1:900 SKOKIE BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4012
Practice Address - Country:US
Practice Address - Phone:847-804-9602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005455133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered