Provider Demographics
NPI:1912366360
Name:RUSSO, ALESSIA (MS,RD,LD)
Entity Type:Individual
Prefix:
First Name:ALESSIA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 WINCHESTER DR
Mailing Address - Street 2:APT 1564
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1564 WINCHESTER DR
Practice Address - Street 2:APT 1564
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2114
Practice Address - Country:US
Practice Address - Phone:440-465-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 7840133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered