Susan Boettcher, RD, LDN
Dietitian, Registered in Oak Lawn, IL. Individual provider (NPI-1).
NPI number1851921100
StatusActive
Last updated in NPPESJan 24, 2020
Details
- NPI
- 1851921100
- Entity type
- Individual (NPI-1)
- Name
- Miss Susan Boettcher
- Credential
- RD, LDN
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 24, 2020
- Certification date
- Jan 24, 2020
- Last updated
- Jan 24, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | 363341 | IL | Yes |
| 133V00000X | Dietitian, Registered | – | – |
Practice location
9409 Menard AveOak Lawn, IL 60453-2337
Phone 708-424-5909
Mailing address
9409 Menard AveOak Lawn, IL 60453-2337
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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