Provider Demographics
NPI:1336442334
Name:HILLYER, MARLENE J (RDN, CSP, CD, CLT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:J
Last Name:HILLYER
Suffix:
Gender:F
Credentials:RDN, CSP, CD, CLT
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:J
Other - Last Name:MALTBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7520 19TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4432
Mailing Address - Country:US
Mailing Address - Phone:206-799-7010
Mailing Address - Fax:206-866-0204
Practice Address - Street 1:8301B 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4118
Practice Address - Country:US
Practice Address - Phone:206-799-7010
Practice Address - Fax:206-866-0204
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60202010133N00000X, 133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2041434Medicaid
WA2041434Medicaid