Provider Demographics
NPI:1891352571
Name:HALLARON, KELLIE (RDN)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:HALLARON
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 1:30361 BALFOUR DRIVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-444-2164
Mailing Address - Fax:
Practice Address - Street 1:101 W. LIBERTY STREET, SUITE 360
Practice Address - Street 2:SUITE 360
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4810
Practice Address - Country:US
Practice Address - Phone:248-444-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15707OtherACADEMY OF NUTRITION AND DIETETICS