Provider Demographics
NPI:1124299987
Name:CASPER, AMY BETH (RD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:CASPER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W IRVING PARK RD
Mailing Address - Street 2:FOOD AND NUTRITION SERVICES
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3077
Mailing Address - Country:US
Mailing Address - Phone:773-975-6807
Mailing Address - Fax:773-975-6767
Practice Address - Street 1:850 W IRVING PARK RD
Practice Address - Street 2:FOOD AND NUTRITION SERVICES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3077
Practice Address - Country:US
Practice Address - Phone:773-975-6807
Practice Address - Fax:773-975-6767
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004027133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered