Provider Demographics
NPI:1548971047
Name:FISCHER, KAITLYN (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:FISCHER
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 1:1021 S CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-2926
Mailing Address - Country:US
Mailing Address - Phone:224-659-8860
Mailing Address - Fax:
Practice Address - Street 1:1021 S CHURCH RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2926
Practice Address - Country:US
Practice Address - Phone:224-659-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008895133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered