KELLY ANN FORMAN Dietitian and Nutritionist License verification

Business Entity

ACTIVE

License Type

Dietitian and Nutritionist

Description

LICENSED DIETITIAN NUTRITIONIST

License Number

164011355

License Status

ACTIVE

Business

First Name

KELLY

Middle

ANN

Last Name

FORMAN

Business Name

KELLY ANN FORMAN

Original Issue Date

11/21/2024

Effective Date

08/04/2025

Expiration Date

10/31/2027

City

SIMSBURY

State

Zip

06070

Ever Disciplined

LastModifiedDate

10/30/2025