Individual
ALLISON JAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4777 E OUTER DR, DETROIT, MI 48234-3241
(313) 369-5853
Mailing address
970 KINGS HWY, LINCOLN PARK, MI 48146-4206
(419) 603-3454
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86004099
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86004099
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
09/29/2019
Last updated
09/29/2019
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