Healthcare Provider Details

I. General information

NPI: 1710752472
Provider Name (Legal Business Name): GUIDED PATH NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/26/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9111 BROADWAY STE D
MERRILLVILLE IN
46410-7092
US

IV. Provider business mailing address

709 PLAZA DR # 154
CHESTERTON IN
46304-1572
US

V. Phone/Fax

Practice location:
  • Phone: 219-327-4756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JUSTYNA BERGHOLZ
Title or Position: REGISTERED DIETITIAN
Credential:
Phone: 219-327-4756