Provider Demographics
NPI:1386350502
Name:VALLAS, MEGAN ANN (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:VALLAS
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YATES CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61572-9206
Mailing Address - Country:US
Mailing Address - Phone:309-712-2479
Mailing Address - Fax:
Practice Address - Street 1:210 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2497
Practice Address - Country:US
Practice Address - Phone:309-647-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164009066133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered