Provider Demographics
NPI:1477857902
Name:MCGEOUGH, ALIA T (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALIA
Middle Name:T
Last Name:MCGEOUGH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8924 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-6263
Mailing Address - Country:US
Mailing Address - Phone:720-851-8637
Mailing Address - Fax:
Practice Address - Street 1:9395 CROWN CREST BLVD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8573
Practice Address - Country:US
Practice Address - Phone:303-269-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO897457133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered