Provider Demographics
NPI:1831976182
Name:ALLYSON COLE PEDIATRIC NUTRITION THERAPY PLLC
Entity type:Organization
Organization Name:ALLYSON COLE PEDIATRIC NUTRITION THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:815-685-1563
Mailing Address - Street 1:3341 W PILGRIMS WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9512
Mailing Address - Country:US
Mailing Address - Phone:815-685-1563
Mailing Address - Fax:309-220-4128
Practice Address - Street 1:3341 W PILGRIMS WAY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9512
Practice Address - Country:US
Practice Address - Phone:815-685-1563
Practice Address - Fax:309-220-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health