Individual
LAURA WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDN, RDN, CPT
Contact information
Practice address
1333 BURR RIDGE PKWY STE 200, BURR RIDGE, IL 60527-0833
(630) 308-8706
Mailing address
808 S ASHLAND AVE, LA GRANGE, IL 60525-2817
(630) 308-8706
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
164002859
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164002859
IL DEPARTMENT OF PROFESSIONAL REGULATION
IL
Enumeration date
06/15/2018
Last updated
06/15/2018
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