Provider Demographics
NPI:1619387255
Name:GACKE, ANNA (MS RD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GACKE
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S MICHIGAN AVE
Mailing Address - Street 2:STE 408
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2857
Mailing Address - Country:US
Mailing Address - Phone:312-567-8793
Mailing Address - Fax:
Practice Address - Street 1:2600 S MICHIGAN AVE
Practice Address - Street 2:STE 408
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2857
Practice Address - Country:US
Practice Address - Phone:312-567-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered