Provider Demographics
NPI:1457163560
Name:KACHELMUSS, MADISON (RDN)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KACHELMUSS
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 1:4818 MCMILLAN LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-1336
Mailing Address - Country:US
Mailing Address - Phone:815-451-5527
Mailing Address - Fax:
Practice Address - Street 1:4818 MCMILLAN LN
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-1336
Practice Address - Country:US
Practice Address - Phone:815-451-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86330862133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered