Provider Demographics
NPI:1770924417
Name:GEHLE, ALYSSA MARIE (MPH, RDN, LN)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:MARIE
Last Name:GEHLE
Suffix:
Gender:F
Credentials:MPH, RDN, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N MAIN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5963
Mailing Address - Country:US
Mailing Address - Phone:605-367-8031
Mailing Address - Fax:605-361-3417
Practice Address - Street 1:521 N MAIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5963
Practice Address - Country:US
Practice Address - Phone:605-367-8031
Practice Address - Fax:605-367-8247
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0612133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD42-0325638OtherEMPLOYEE TAX ID