Provider Demographics
NPI:1356953004
Name:HAYES, BLAIR J (RDN, LDN)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:J
Last Name:HAYES
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 1:1 E ERIE ST STE 525
Mailing Address - Street 2:#227
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2980
Mailing Address - Country:US
Mailing Address - Phone:224-357-6599
Mailing Address - Fax:
Practice Address - Street 1:1 E ERIE ST STE 525
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2980
Practice Address - Country:US
Practice Address - Phone:224-357-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008089133V00000X
IL008089133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered