Individual
LILLIE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETICIAN
Contact information
Practice address
285 MEMORIAL DR, CRYSTAL LAKE, IL 60014-6260
(815) 356-2383
(815) 356-2385
Mailing address
13707 W JACKSON ST, WOODSTOCK, IL 60098-3141
(815) 206-1067
(815) 338-6297
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
IL
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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