Provider Demographics
NPI:1902197155
Name:GONZALEZ, MONICA HAYDEE (RD,LDN,CDE)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:HAYDEE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RD,LDN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 E BELVIDERE RD STE 185
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2026
Mailing Address - Country:US
Mailing Address - Phone:847-534-3278
Mailing Address - Fax:847-535-7260
Practice Address - Street 1:1475 E BELVIDERE RD STE 185
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2026
Practice Address - Country:US
Practice Address - Phone:847-534-3278
Practice Address - Fax:847-535-7260
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005449133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered