Healthcare Provider Details

I. General information

NPI: 1972986933
Provider Name (Legal Business Name): ALEA KAY OLSON R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ROOSEVELT RD
GLEN ELLYN IL
60137-5806
US

IV. Provider business mailing address

211 W WACKER DR STE 1150
CHICAGO IL
60606-1785
US

V. Phone/Fax

Practice location:
  • Phone: 630-984-2200
  • Fax:
Mailing address:
  • Phone: 312-878-8800
  • Fax: 312-448-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.006454
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: