Provider Demographics
NPI:1215253711
Name:SWANK, GRETCHEN (RD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:SWANK
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 1:259 E ERIE ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3907
Mailing Address - Country:US
Mailing Address - Phone:312-926-1300
Mailing Address - Fax:312-926-2424
Practice Address - Street 1:259 E ERIE ST STE 2100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3907
Practice Address - Country:US
Practice Address - Phone:312-926-1300
Practice Address - Fax:312-926-2424
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004416133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164004416OtherIL LICENSE