Provider Demographics
NPI:1639891567
Name:DEIG, SARAH E (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:DEIG
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15315 W GLASFORD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:GLASFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61533-9738
Mailing Address - Country:US
Mailing Address - Phone:309-360-5680
Mailing Address - Fax:
Practice Address - Street 1:420 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3106
Practice Address - Country:US
Practice Address - Phone:309-624-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management