Provider Demographics
NPI:1992999742
Name:GRAHAM, CATHERINE MARIE (RD, LDN, CDE)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N BERTEAU AVE
Mailing Address - Street 2:DIABETES CENTER
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2966
Mailing Address - Country:US
Mailing Address - Phone:630-993-5108
Mailing Address - Fax:630-993-5484
Practice Address - Street 1:200 N BERTEAU AVE
Practice Address - Street 2:DIABETES CENTER
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2966
Practice Address - Country:US
Practice Address - Phone:630-993-5108
Practice Address - Fax:630-993-5484
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered