Individual
MS. SUSAN R. WITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
1460 N SANDBURG TER, #301A, CHICAGO, IL 60610-8514
(312) 944-0855
(312) 944-0855
Mailing address
1460 N SANDBURG TER, #301A, CHICAGO, IL 60610-8514
(312) 944-0855
(312) 944-0855
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.000255
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164.000256
STATE OF ILLINOIS , DIVISION OF PROFESSIONAL REGULATION, LICENSE
IL
01
—
636084
REGISTERED DIETITIAN, ACADEMY OF NUTRITION AND DIETETICS
IL
Enumeration date
02/01/2014
Last updated
02/01/2014
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