Provider Demographics
NPI:1841972387
Name:THAT FOODIE DIETITIAN LLC
Entity type:Organization
Organization Name:THAT FOODIE DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIGITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:815-260-9692
Mailing Address - Street 1:2735 HASSERT BLVD
Mailing Address - Street 2:STE 135 #804
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:424 FREEHAUF ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4349
Practice Address - Country:US
Practice Address - Phone:815-260-9692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty