Provider Demographics
NPI:1588968648
Name:ELLISON, MEGAN MARIE (MS, RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:ELLISON
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 206TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7817
Mailing Address - Country:US
Mailing Address - Phone:206-914-1904
Mailing Address - Fax:425-354-3544
Practice Address - Street 1:3203 206TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7817
Practice Address - Country:US
Practice Address - Phone:206-914-1904
Practice Address - Fax:425-354-3544
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60178596133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered