Provider Demographics
NPI:1023644960
Name:BOGASH, LYNNSEY NICOLE (RD, LDN)
Entity type:Individual
Prefix:
First Name:LYNNSEY
Middle Name:NICOLE
Last Name:BOGASH
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 1:515 W WRIGHTWOOD AVE APT 507
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1707
Mailing Address - Country:US
Mailing Address - Phone:815-274-8731
Mailing Address - Fax:
Practice Address - Street 1:5838 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4916
Practice Address - Country:US
Practice Address - Phone:773-769-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007734133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered