Provider Demographics
NPI:1396063889
Name:HAUSER, TALIA ANN (LICENSED DIETICIAN)
Entity type:Individual
Prefix:MS
First Name:TALIA
Middle Name:ANN
Last Name:HAUSER
Suffix:
Gender:F
Credentials:LICENSED DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ELM ST
Mailing Address - Street 2:STE 4360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4701
Mailing Address - Country:US
Mailing Address - Phone:847-723-2210
Mailing Address - Fax:
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:ADVOCATE LUTHERAN GENERAL HOSPITAL
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-723-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005073133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164005073OtherSTATE OF IL DIETITIAN LICENSE