Individual
ASHLEY THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD/LDN
Contact information
Practice address
1609 W MOSS AVE, PEORIA, IL 61606-1642
(434) 108-2338
Mailing address
1609 W MOSS AVE, PEORIA, IL 61606-1642
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164005964
IL
Other
Enumeration date
05/05/2015
Last updated
01/03/2019
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