Provider Demographics
NPI:1043871569
Name:BLS NUTRITION CONSULTING LLC
Entity Type:Organization
Organization Name:BLS NUTRITION CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOGUSLAWA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-239-0019
Mailing Address - Street 1:1900 E GOLF RD STE 950-H
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5834
Mailing Address - Country:US
Mailing Address - Phone:847-239-0019
Mailing Address - Fax:
Practice Address - Street 1:1900 E GOLF RD STE 950-H
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5834
Practice Address - Country:US
Practice Address - Phone:872-395-6294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty