Provider Demographics
NPI:1144901794
Name:GOLAN, KRISTEN (MS, RD, LDN, CSG)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GOLAN
Suffix:
Gender:F
Credentials:MS, RD, LDN, CSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 N ARTESIAN AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0768
Mailing Address - Country:US
Mailing Address - Phone:949-735-9940
Mailing Address - Fax:
Practice Address - Street 1:1722 N ARTESIAN AVE APT 3F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-0768
Practice Address - Country:US
Practice Address - Phone:949-735-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered