# PATHWAY DIETETICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831493162
- **Authorized official:** MS. GAYLE O BOOTH MS RD LDN CDE (OWNER/REGISTERED DIETITIAN)
- **Authorized official phone:** (847) 354-5584

## Contact information

- **Practice address:** 415 MACHELLE DR, CARY, IL 60013-2399
- **Practice address phone:** (847) 354-5584
- **Practice address fax:** (888) 788-2497
- **Mailing address:** 415 MACHELLE DR, CARY, IL 60013-2399
- **Mailing address phone:** (847) 354-5584
- **Mailing address fax:** (888) 788-2497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 164.001309 | IL | Yes |

## Other

- **Enumeration date:** 12/30/2010
- **Last updated:** 03/07/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 164.001309 | STATE OF IL DIVISION OF PROFESSIONAL REGULATION | IL |