Individual
GRACE TIVNAN WHITEFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CSSD, LDN
Contact information
Practice address
997 N CORPORATE CIR, GRAYSLAKE, IL 60030-7822
(847) 868-3435
Mailing address
206 KENLOCH AVE, LIBERTYVILLE, IL 60048-1770
(847) 849-7647
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164004293
IL
Other
Enumeration date
03/22/2007
Last updated
10/15/2013
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