Provider Demographics
NPI:1194376244
Name:KOCH, ALLISON PARKER (RDN, CSSD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:PARKER
Last Name:KOCH
Suffix:
Gender:F
Credentials:RDN, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5606
Mailing Address - Country:US
Mailing Address - Phone:847-825-0770
Mailing Address - Fax:312-648-0155
Practice Address - Street 1:826 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3352
Practice Address - Country:US
Practice Address - Phone:847-825-0070
Practice Address - Fax:312-648-0155
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006301133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered