Healthcare Provider Details

I. General information

NPI: 1578039996
Provider Name (Legal Business Name): ALYSON HAEBIG RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST STE 525
CHICAGO IL
60611-2980
US

IV. Provider business mailing address

522 W RIVERSIDE AVE # 7639
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 920-539-3454
  • Fax:
Mailing address:
  • Phone: 920-539-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86084099
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: