Provider Demographics
NPI:1700023033
Name:WAY TO GROW NUTRITION THERAPY, LLC
Entity Type:Organization
Organization Name:WAY TO GROW NUTRITION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERD DIETITIAN/NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRUTZA
Authorized Official - Suffix:
Authorized Official - Credentials:RD/LDN
Authorized Official - Phone:815-207-1240
Mailing Address - Street 1:22840 EIDER CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-4506
Mailing Address - Country:US
Mailing Address - Phone:815-207-1240
Mailing Address - Fax:630-206-1656
Practice Address - Street 1:22840 EIDER CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-4506
Practice Address - Country:US
Practice Address - Phone:815-207-1240
Practice Address - Fax:630-206-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003339133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty