Provider Demographics
NPI:1154838530
Name:VOLLING, SARAH MAE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MAE
Last Name:VOLLING
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7407 CONNER LN
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4669
Mailing Address - Country:US
Mailing Address - Phone:913-314-0145
Mailing Address - Fax:
Practice Address - Street 1:60 S STATE ROUTE 157
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025
Practice Address - Country:US
Practice Address - Phone:913-314-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-06
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017004357133V00000X
IL164.007078133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered