Provider Demographics
NPI:1750851770
Name:WESSELL, ALLISON (MS, RD, LD, CLS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WESSELL
Suffix:
Gender:F
Credentials:MS, RD, LD, CLS
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD, CLS
Mailing Address - Street 1:13110 BRINT RD
Mailing Address - Street 2:
Mailing Address - City:BERKEY
Mailing Address - State:OH
Mailing Address - Zip Code:43504-9715
Mailing Address - Country:US
Mailing Address - Phone:440-813-3969
Mailing Address - Fax:
Practice Address - Street 1:400 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3825
Practice Address - Country:US
Practice Address - Phone:517-577-6250
Practice Address - Fax:517-263-6531
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7806133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered