Healthcare Provider Details

I. General information

NPI: 1174430805
Provider Name (Legal Business Name): YVETTE C GAUGHAN MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 CONIFER LN
GURNEE IL
60031-6353
US

IV. Provider business mailing address

5209 CONIFER LN
GURNEE IL
60031-6353
US

V. Phone/Fax

Practice location:
  • Phone: 773-255-3710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164000779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: