Provider Demographics
NPI:1467330134
Name:OSOWSKI, LISA MARIE (MS, RD, CDCES, LDN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:OSOWSKI
Suffix:
Gender:F
Credentials:MS, RD, CDCES, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-6715
Mailing Address - Fax:
Practice Address - Street 1:2151 WAUKEGAN RD STE 140
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1868
Practice Address - Country:US
Practice Address - Phone:847-982-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered