Provider Demographics
NPI:1770196776
Name:ARDUINI, KATHERINE JADE (RD, LDN, CLS)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JADE
Last Name:ARDUINI
Suffix:
Gender:F
Credentials:RD, LDN, CLS
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:JADE
Other - Last Name:ARDUINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN, CLS
Mailing Address - Street 1:2636 W WINNEMAC AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2733
Mailing Address - Country:US
Mailing Address - Phone:312-227-6771
Mailing Address - Fax:312-227-9413
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6771
Practice Address - Fax:312-227-9413
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006335133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric