Gustafson, Carly D

Gustafson, Carly D is an individual health care provider with primary practice located at 4100 W 42Nd Street , Chicago IL 60632. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Gustafson, Carly D can be contacted via phone (773) 843-6709.

Contact Information

Primary practice address
4100 W 42Nd Street Chicago IL 60632
Phone: (773) 843-6709
Fax: (773) 843-2748
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X Illinois

Profile Details

NPI number 1811993074
LBN Legal business name Gustafson, Carly D
Credentials MS RD LDN
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2005
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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