Provider Demographics
NPI:1679011134
Name:CACCIATORE, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CACCIATORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:COOK-CACCIATORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD LDN
Mailing Address - Street 1:430 ASHBURY DR
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4991
Mailing Address - Country:US
Mailing Address - Phone:630-207-7401
Mailing Address - Fax:
Practice Address - Street 1:430 ASHBURY DR
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4991
Practice Address - Country:US
Practice Address - Phone:630-207-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001003133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164.001003OtherSTATE LICENSE