Provider Demographics
NPI:1386157527
Name:MAYSZAK, COURTNEY (RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:MAYSZAK
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CENTRAL AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3246
Mailing Address - Country:US
Mailing Address - Phone:847-681-5513
Mailing Address - Fax:
Practice Address - Street 1:777 CENTRAL AVE STE 4
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3246
Practice Address - Country:US
Practice Address - Phone:847-681-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
IL164.007068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist