Provider Demographics
NPI:1144572603
Name:GOLDUFSKY, CATHLYNN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:CATHLYNN
Middle Name:
Last Name:GOLDUFSKY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 WAUKEGAN RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1543
Mailing Address - Country:US
Mailing Address - Phone:847-236-0943
Mailing Address - Fax:
Practice Address - Street 1:2201 WAUKEGAN RD
Practice Address - Street 2:SUITE 170
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1543
Practice Address - Country:US
Practice Address - Phone:847-236-0943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005792133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered