Provider Demographics
NPI:1043021801
Name:WILLETT, ALLISON (RDN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WILLETT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:REAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:6910 QUINCY AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7153
Mailing Address - Country:US
Mailing Address - Phone:616-685-5003
Mailing Address - Fax:
Practice Address - Street 1:300 LAFAYETTE AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4692
Practice Address - Country:US
Practice Address - Phone:616-685-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered