Provider Demographics
NPI:1568268407
Name:REINER, JENNIFER (RDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REINER
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2520
Mailing Address - Country:US
Mailing Address - Phone:630-930-3615
Mailing Address - Fax:
Practice Address - Street 1:1225 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2520
Practice Address - Country:US
Practice Address - Phone:630-930-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004274133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered