Provider Demographics
NPI:1114742061
Name:DINNOCENZO, ALLISON MARIE (RD, LDN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:DINNOCENZO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13062 W CHOCTAW TRL
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8607
Mailing Address - Country:US
Mailing Address - Phone:630-638-0440
Mailing Address - Fax:
Practice Address - Street 1:1621 ANDREA DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2303
Practice Address - Country:US
Practice Address - Phone:630-638-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005137133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered