Healthcare Provider Details

I. General information

NPI: 1992686331
Provider Name (Legal Business Name): KATIE TRUMPY BCHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 W STATE LINE RD
WINSLOW IL
61089-9403
US

IV. Provider business mailing address

8131 W STATE LINE RD
WINSLOW IL
61089-9403
US

V. Phone/Fax

Practice location:
  • Phone: 815-821-3396
  • Fax: 815-821-3396
Mailing address:
  • Phone: 815-821-3396
  • Fax: 815-821-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: