Provider Demographics
NPI:1548775505
Name:BENSON, ALLISON JADE (RD, LRD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JADE
Last Name:BENSON
Suffix:
Gender:F
Credentials:RD, LRD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:JADE
Other - Last Name:DHUYVETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LRD
Mailing Address - Street 1:705 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-3325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 4TH ST SE
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-3325
Practice Address - Country:US
Practice Address - Phone:701-965-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1007133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered