Provider Demographics
NPI:1326563818
Name:HEUS, ALLYSSA M (RD, LD)
Entity Type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:M
Last Name:HEUS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:ALLYSSA
Other - Middle Name:
Other - Last Name:MAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:5202 BETHEL REED PARK STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1818
Mailing Address - Country:US
Mailing Address - Phone:614-447-9495
Mailing Address - Fax:614-447-9163
Practice Address - Street 1:5202 BETHEL REED PARK STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1818
Practice Address - Country:US
Practice Address - Phone:614-447-9495
Practice Address - Fax:614-447-9163
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08260133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0402690Medicaid