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General NPI Number Information
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NPI Number | 1740136712
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Entity Type | Organization
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Legal Business Name | GRACE KELLEY NUTRITION LLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 3838 N RAVENSWOOD AVE # 308
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City | CHICAGO
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State | IL
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Zip | 60613-5651
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Country | US
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Telephone | 440-986-0360
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Fax |
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Provider Business Mailing Address
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Address Line | 2909 N SHERIDAN RD APT 1806
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City | CHICAGO
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State | IL
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Zip | 60657-5946
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Country | US
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Telephone | 440-986-0360
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Fax |
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Authorized Official
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Title or Position | SPORTS DIETITIAN
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Name | GRACE A KELLEY
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Credential | RDN, LD
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Telephone | 440-986-0360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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