Provider Demographics
NPI:1811305253
Name:KNAPPENBERGER, KATE (MS, RD, CSSD, ATC)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:KNAPPENBERGER
Suffix:
Gender:F
Credentials:MS, RD, CSSD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 CHICAGO AVE APT 309B
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-6514
Mailing Address - Country:US
Mailing Address - Phone:920-655-8018
Mailing Address - Fax:
Practice Address - Street 1:1501 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0840
Practice Address - Country:US
Practice Address - Phone:920-655-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered