Provider Demographics
NPI:1972713204
Name:LINK, KATHY (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:LINK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD LDN
Mailing Address - Street 1:722 N MELVIN ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1145
Mailing Address - Country:US
Mailing Address - Phone:217-249-5881
Mailing Address - Fax:217-784-8559
Practice Address - Street 1:722 N MELVIN ST
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1145
Practice Address - Country:US
Practice Address - Phone:217-249-5881
Practice Address - Fax:217-784-8559
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered