Provider Demographics
NPI:1427446327
Name:WOLFF, JORDANA (RD LDN)
Entity type:Individual
Prefix:
First Name:JORDANA
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6942
Mailing Address - Country:US
Mailing Address - Phone:312-640-1737
Mailing Address - Fax:
Practice Address - Street 1:2445 HAMPTON LN
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6942
Practice Address - Country:US
Practice Address - Phone:312-640-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003870133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered