SUSAN B FORMALES Dietitian and Nutritionist License verification

Business Entity

ACTIVE

License Type

Dietitian and Nutritionist

Description

LICENSED DIETITIAN NUTRITIONIST

License Number

164004171

License Status

ACTIVE

Business

First Name

SUSAN

Middle

Last Name

FORMALES

Business Name

SUSAN B FORMALES

Original Issue Date

08/06/2004

Effective Date

10/15/2025

Expiration Date

10/31/2027

City

ELGIN

State

Zip

60123

Ever Disciplined

LastModifiedDate

10/15/2025