Organization
TLC NUTRITION THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY L CICIRALE RD (REGISTERED DIETITIAN)
(708) 705-4881
Entity
Organization
Contact information
Practice address
16609 BLACKFOOT DR, LOCKPORT, IL 60441-1501
(708) 705-4881
Mailing address
16609 BLACKFOOT DR, LOCKPORT, IL 60441-1501
(708) 705-4881
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164000861
IL
Other
Enumeration date
03/20/2017
Last updated
03/20/2017
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