Provider Demographics
NPI:1316793532
Name:SONG, EMILY CATHERINE (RDN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CATHERINE
Last Name:SONG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3311
Mailing Address - Country:US
Mailing Address - Phone:224-433-3271
Mailing Address - Fax:
Practice Address - Street 1:1531 S GROVE AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5240
Practice Address - Country:US
Practice Address - Phone:817-205-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.009885133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered