Susan Boettcher, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

363341 Issued in IL

Practice address

9409 Menard Ave
Oak Lawn, IL 60453-2337

Phone

(708) 424-5909

NPI assigned

Jan 24, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1851921100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9409 MENARD AVE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9409 MENARD AVE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532337",
            "telephone_number": "708-424-5909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTCHER",
        "first_name": "SUSAN",
        "name_prefix": "Miss",
        "credential": "RD, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-24",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "363341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Jesse Blockson
• Brian Blumenstein, MD
• Wilfred Boarden, M.D.
• Vishal Bobba, MD
• Sarah Boersma, FNP
• Bhagyalakshmi Gopal Boggaram, MD
• Michele Beth Bohne
• Elizabeth Ann Bojda
• Keema Petria Boland-Bryant, CRNP
• Jonathan Wyatt Bold, M.D.

• Registered Dietitian in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.