Provider Demographics
NPI:1063966513
Name:FEINGOLD, MARLA
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:FEINGOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 W ADDISON ST
Mailing Address - Street 2:2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6135
Mailing Address - Country:US
Mailing Address - Phone:773-656-1725
Mailing Address - Fax:
Practice Address - Street 1:2147 W ADDISON ST
Practice Address - Street 2:2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6135
Practice Address - Country:US
Practice Address - Phone:773-656-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006133133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist