Provider Demographics
NPI:1912089392
Name:CLAYSEN, CATHERINE JOANNE (MSRDLD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JOANNE
Last Name:CLAYSEN
Suffix:
Gender:F
Credentials:MSRDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 WOODBINE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-8609
Mailing Address - Country:US
Mailing Address - Phone:219-462-6355
Mailing Address - Fax:
Practice Address - Street 1:201 EAST HURON RENAL CLINIC
Practice Address - Street 2:NORTHWESTERN MEMORIAL HOSPITAL- GALTER BUILDING
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3008
Practice Address - Country:US
Practice Address - Phone:312-695-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered