Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Wild Table PLLC

Organization Registered Dietitian · NPI 1174327209

Wild Table PLLC is a Registered Dietitian in Chicago, Illinois. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

740 N Ogden Ave Apt 4
Chicago, IL 60642-7063
Phone: (608) 438-1612
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X

Record details

NPI number1174327209
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ingrid Clark — Registered Dietitian · (608) 438-1612
NPI enumeratedApril 1, 2025
Last updated in NPPESApril 1, 2025
Certification dateApril 1, 2025
Mailing address1842 N Albany Ave, Chicago, IL 60647-5073

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