Provider Demographics
NPI:1962874297
Name:BROWN, KATHRYN (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BROWN
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 1:325 W CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4294
Mailing Address - Country:US
Mailing Address - Phone:847-609-6654
Mailing Address - Fax:
Practice Address - Street 1:325 W CALDWELL DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-4294
Practice Address - Country:US
Practice Address - Phone:847-609-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86012436133V00000X
IL164.006550133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered