Provider Demographics
NPI:1992821219
Name:CONWAY, JENNIFER WOODS (RD,LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WOODS
Last Name:CONWAY
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 1:5328 FAWN CT
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2200
Mailing Address - Country:US
Mailing Address - Phone:708-305-4402
Mailing Address - Fax:708-535-2268
Practice Address - Street 1:5328 FAWN CT
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2200
Practice Address - Country:US
Practice Address - Phone:708-305-4402
Practice Address - Fax:708-535-2268
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric