Provider Demographics
NPI:1780888909
Name:RIFFE, LYNDSAY ROSE (RD)
Entity type:Individual
Prefix:MRS
First Name:LYNDSAY
Middle Name:ROSE
Last Name:RIFFE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 N LINCOLN AVE
Mailing Address - Street 2:#203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3179
Mailing Address - Country:US
Mailing Address - Phone:773-322-7292
Mailing Address - Fax:773-775-9714
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:STE 569
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-775-9574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered