Provider Demographics
NPI:1508696535
Name:CAVANAUGH, MARGARET A (RDN, LDN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ADDISON AVE UNIT 314
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3082
Mailing Address - Country:US
Mailing Address - Phone:630-407-7113
Mailing Address - Fax:
Practice Address - Street 1:125 S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3245
Practice Address - Country:US
Practice Address - Phone:630-407-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164010868133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty