Individual
KIRBY WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CLC
Contact information
Practice address
3817 N CENTRAL PARK AVE, CHICAGO, IL 60618-4102
(312) 502-3345
Mailing address
3817 N CENTRAL PARK AVE, CHICAGO, IL 60618-4102
(312) 502-3345
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86017636
IL
174N00000X
Lactation Consultant (Non-RN)
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—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86017636
REGISTERED DIETITIAN LICENSE
IL
Enumeration date
03/12/2019
Last updated
06/11/2019
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