Organization
PATHWAY DIETETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAYLE O BOOTH MS RD LDN CDE (OWNER/REGISTERED DIETITIAN)
(847) 354-5584
Entity
Organization
Contact information
Practice address
415 MACHELLE DR, CARY, IL 60013-2399
(847) 354-5584
(888) 788-2497
Mailing address
415 MACHELLE DR, CARY, IL 60013-2399
(847) 354-5584
(888) 788-2497
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
164.001309
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164.001309
STATE OF IL DIVISION OF PROFESSIONAL REGULATION
IL
Enumeration date
12/30/2010
Last updated
03/07/2015
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