Provider Demographics
NPI:1699368787
Name:INGLE, KATHERINE A (RD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:INGLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:840 SOUTH WOOD STREET
Mailing Address - Street 2:PEDIATRIC GENETICS 12TH FLOOR M/C 856
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-9283
Mailing Address - Fax:312-355-0739
Practice Address - Street 1:840 SOUTH WOOD STREET
Practice Address - Street 2:PEDIATRIC GENETICS 12TH FLOOR M/C 856
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-996-9283
Practice Address - Fax:312-355-0739
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006904133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic