Healthcare Provider Details

I. General information

NPI: 1700926342
Provider Name (Legal Business Name): KATHRYN ANN LIPARI R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN WALKER

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S LAKE PARK AVE STE 200
HOBART IN
46342-6790
US

IV. Provider business mailing address

10737 HENDRICKS PL
CROWN POINT IN
46307-2926
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6122
  • Fax: 219-947-6045
Mailing address:
  • Phone: 219-661-1769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001630A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: