Healthcare Provider Details

I. General information

NPI: 1164387874
Provider Name (Legal Business Name): CATHERINE WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

1250 S TOWER RD
DAWSON IL
62520-3189
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-1339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number164.008756
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: