Provider Demographics
NPI:1487326989
Name:PERIAN, JEANNE M (RDN, LDN)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:PERIAN
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9521 STEELE CT
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-7181
Mailing Address - Country:US
Mailing Address - Phone:815-670-3119
Mailing Address - Fax:
Practice Address - Street 1:9521 STEELE CT
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-7181
Practice Address - Country:US
Practice Address - Phone:815-670-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered