Provider Demographics
NPI:1275110827
Name:COONEY, ALISON M (MS, RDN)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:M
Last Name:COONEY
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54511 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1012
Mailing Address - Country:US
Mailing Address - Phone:586-747-5108
Mailing Address - Fax:
Practice Address - Street 1:54511 AVONDALE DR
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-1012
Practice Address - Country:US
Practice Address - Phone:586-747-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86173497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered