Provider Demographics
NPI:1467690099
Name:TINY TOTS NUTRITION THERAPY LLC
Entity Type:Organization
Organization Name:TINY TOTS NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEDZIERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:815-919-0312
Mailing Address - Street 1:16406 S WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7666
Mailing Address - Country:US
Mailing Address - Phone:815-919-0312
Mailing Address - Fax:815-305-7403
Practice Address - Street 1:16406 S WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-7666
Practice Address - Country:US
Practice Address - Phone:815-919-0312
Practice Address - Fax:815-305-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003138133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty