Provider Demographics
NPI:1124547955
Name:TASCHUK, ALLIE JO (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:JO
Last Name:TASCHUK
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SE LOOP 820 RM 2N-121
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-5863
Mailing Address - Country:US
Mailing Address - Phone:817-730-0028
Mailing Address - Fax:
Practice Address - Street 1:2201 SE LOOP 820 RM 2N-121
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5863
Practice Address - Country:US
Practice Address - Phone:817-730-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84664133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT84664OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION
86054371OtherCOMMISSION ON DIETETIC REGISTRATION (CDR)