Basic Information
| Provider Information | |||||||||
| NPI: | 1205200086 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLATZ | ||||||||
| FirstName: | VICTORIA | ||||||||
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| Credential: | RD, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 E HAWTHORN PKWY | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | VERNON HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600611463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478683435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 E OGDEN AVE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | HINSDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605213542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478683435 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2015 | ||||||||
| LastUpdateDate: | 11/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 164006650 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.