Provider Demographics
NPI:1801404462
Name:CASTREJON, KATHLEEN (RD,LDN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CASTREJON
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 RENEE TER
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-4625
Mailing Address - Country:US
Mailing Address - Phone:847-338-3607
Mailing Address - Fax:
Practice Address - Street 1:284 RENEE TER
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-4625
Practice Address - Country:US
Practice Address - Phone:847-338-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007969133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered