Provider Demographics
NPI:1477383784
Name:SOLID GROUND NUTRITION THERAPY LLC
Entity type:Organization
Organization Name:SOLID GROUND NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN, CEDS
Authorized Official - Phone:708-462-2707
Mailing Address - Street 1:106 W CALENDAR AVE # 191
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2325
Mailing Address - Country:US
Mailing Address - Phone:708-462-2707
Mailing Address - Fax:
Practice Address - Street 1:5243 S NORMANDY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-1227
Practice Address - Country:US
Practice Address - Phone:773-316-2737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty