Provider Demographics
NPI: | 1548748676 |
---|---|
Name: | EAT PRACTICAL LLC |
Entity Type: | Organization |
Organization Name: | EAT PRACTICAL LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PROVIDER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SARAH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VOLLING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, RD, LDN, CLT |
Authorized Official - Phone: | 913-314-0145 |
Mailing Address - Street 1: | 7407 CONNER LN |
Mailing Address - Street 2: | |
Mailing Address - City: | EDWARDSVILLE |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 62025-4669 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 913-314-0145 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7407 CONNER LN |
Practice Address - Street 2: | |
Practice Address - City: | EDWARDSVILLE |
Practice Address - State: | IL |
Practice Address - Zip Code: | 62025-4669 |
Practice Address - Country: | US |
Practice Address - Phone: | 913-314-0145 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-07-31 |
Last Update Date: | 2018-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 164.007078 | 133V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Single Specialty |