Provider Demographics
NPI:1902022866
Name:SIMON, HONORA (PHD, RD)
Entity Type:Individual
Prefix:DR
First Name:HONORA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S MICHIGAN AVE
Mailing Address - Street 2:#1310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2356
Mailing Address - Country:US
Mailing Address - Phone:312-939-9594
Mailing Address - Fax:312-939-9594
Practice Address - Street 1:910 S MICHIGAN AVE
Practice Address - Street 2:#1310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2356
Practice Address - Country:US
Practice Address - Phone:312-939-9594
Practice Address - Fax:312-939-9594
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133N00000X, 103TH0004X, 103TB0200X, 103TC0700X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1672418OtherBLUE CROSS BLUE SHIELD