Provider Demographics
NPI:1518643626
Name:BRECHT, ALISSA J (RDN)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:J
Last Name:BRECHT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18289 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4019
Mailing Address - Country:US
Mailing Address - Phone:248-660-4485
Mailing Address - Fax:
Practice Address - Street 1:18289 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-4019
Practice Address - Country:US
Practice Address - Phone:248-660-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86091417133V00000X
86091417133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology