Provider Demographics
NPI:1164039384
Name:SCHMIDT, KATIE M (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:SCHMIDT
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 1:17 W 56TH ST
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2301
Mailing Address - Country:US
Mailing Address - Phone:708-278-0084
Mailing Address - Fax:
Practice Address - Street 1:17 W 56TH ST
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2301
Practice Address - Country:US
Practice Address - Phone:708-278-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty