Provider Demographics
NPI:1467193037
Name:WILLIAMS, GRACE (RDN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:CUCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 N MICHIGAN AVE STE 932
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3910
Mailing Address - Country:US
Mailing Address - Phone:312-772-5566
Mailing Address - Fax:
Practice Address - Street 1:333 MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3844
Practice Address - Country:US
Practice Address - Phone:312-772-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86172388133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86172388OtherCOMMISSION ON DIETETIC REGISTRATION-BOARD CERTIFICATION