Provider Demographics
NPI:1407097223
Name:KABOGO, JANE GATHONI (MS RD LDN)
Entity Type:Individual
Prefix:MISS
First Name:JANE
Middle Name:GATHONI
Last Name:KABOGO
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W ENTERPRISE DR
Mailing Address - Street 2:APT 112
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5880
Mailing Address - Country:US
Mailing Address - Phone:773-978-7370
Mailing Address - Fax:
Practice Address - Street 1:305 W ENTERPRISE DR
Practice Address - Street 2:APT 107
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:773-978-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004360133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered