HOLLY MARLA FORMAN Dietitian and Nutritionist License verification

Business Entity

NOT RENEWED

License Type

Dietitian and Nutritionist

Description

LICENSED DIETITIAN NUTRITIONIST

License Number

164002930

License Status

NOT RENEWED

Business

First Name

HOLLY MARLA

Last Name

FORMAN

Business Name

HOLLY MARLA FORMAN

Original Issue Date

12/19/1997

Expiration Date

10/31/2001

City

NORTHBROOK

State

Zip

60062

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005