Provider Demographics
NPI:1104637974
Name:SUMMIT WELLNESS AND NUTRITION PLLC
Entity type:Organization
Organization Name:SUMMIT WELLNESS AND NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAITLYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED DIETITIAN
Authorized Official - Phone:847-436-2248
Mailing Address - Street 1:119 S WESTERN AVE
Mailing Address - Street 2:UNIT 1 SUITE 230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:847-436-2248
Mailing Address - Fax:
Practice Address - Street 1:3354 N RACINE AVE APT A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8117
Practice Address - Country:US
Practice Address - Phone:847-436-2248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty