Provider Demographics
NPI:1770982142
Name:LYTWYN, ASHLEY MARIE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:LYTWYN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2789 MADERA DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1823
Mailing Address - Country:US
Mailing Address - Phone:860-810-4673
Mailing Address - Fax:877-516-4391
Practice Address - Street 1:2789 MADERA DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1823
Practice Address - Country:US
Practice Address - Phone:860-810-4673
Practice Address - Fax:877-516-4391
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86002175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered