SUSAN JEAN BASALA Dietitian and Nutritionist License verification

Business Entity

INACTIVE

License Type

Dietitian and Nutritionist

Description

LICENSED DIETITIAN NUTRITIONIST

License Number

164002594

License Status

INACTIVE

Business

First Name

SUSAN JEAN

Last Name

BASALA

Business Name

SUSAN JEAN BASALA

Original Issue Date

04/24/1996

Expiration Date

10/31/1997

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

07/28/2005