Provider Demographics
NPI:1205237898
Name:DEBORD, ALYSSA (MS, RD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DEBORD
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E ELM ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-1462
Mailing Address - Country:US
Mailing Address - Phone:206-294-2425
Mailing Address - Fax:
Practice Address - Street 1:110 E ELM ST STE B
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1462
Practice Address - Country:US
Practice Address - Phone:206-294-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
OH08569133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered