Provider Demographics
NPI:1447779145
Name:ALLISON, JESSICA ANN (RDN, CD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:ALLISON
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:MACKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CD
Mailing Address - Street 1:4426 23RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3202
Mailing Address - Country:US
Mailing Address - Phone:360-903-1038
Mailing Address - Fax:
Practice Address - Street 1:673 WOODLAND SQUARE LOOP SE STE 330
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1066
Practice Address - Country:US
Practice Address - Phone:888-364-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60793911133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered