Provider Demographics
NPI:1629176888
Name:MADLEM, ALISON (RD, LD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MADLEM
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10355 SE 97TH CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-7218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:507 NE 47TH AVE
Practice Address - Street 2:LEVEL B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2236
Practice Address - Country:US
Practice Address - Phone:503-215-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered