| Wild Table Pllc | |
|
740 N Ogden Ave Apt 4, Chicago, IL 60642-7063 | |
| (608) 438-1612 | |
| Not Available |
| Full Name | Wild Table Pllc |
|---|---|
| Type | Facility |
| Speciality | Dietitian, Registered |
| Location | 740 N Ogden Ave Apt 4, Chicago, Illinois |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174327209 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | (NU) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Table Pllc 1842 N Albany Ave, Chicago, IL 60647-5073 Ph: (608) 438-1612 | Wild Table Pllc 740 N Ogden Ave Apt 4, Chicago, IL 60642-7063 Ph: (608) 438-1612 |
Mrs. Marissa Lynn Varner, R.D, M.S. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 7435 W Talcott Ave, Health Management Office, Chicago, IL 60631 Phone: 773-594-7448 Fax: 773-594-8454 |
Mrs. Mireya E Renteria, RD, LDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2355 S Western Ave, Chicago, IL 60608 Phone: 773-650-1220 Fax: 773-650-1218 |
Vanessa Alicea Matos, R.D. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2003 W Fulton St, Suite 105, Chicago, IL 60612 Phone: 312-850-3438 Fax: 312-638-9872 |
Mrs. Renee Ann Clerkin, R.D. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2300 W Wabansia Ave, Unit 214, Chicago, IL 60647 Phone: 317-442-5134 |
Elizabeth Murphy, RDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1015 W Lawrence Ave, Chicago, IL 60640 Phone: 773-751-1731 |
Alice Touma, RDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1525 W Homer St Ste 101, Chicago, IL 60642 Phone: 888-785-7370 |
Miss Jun Phan, RDN,LDN Dietitian Medicare: Accepting Medicare Assignments Practice Location: 850 W Irving Park Rd, Chicago, IL 60613 Phone: 773-975-6802 |