Provider Demographics
NPI:1972986933
Name:OLSON, ALEA KAY (RDN)
Entity type:Individual
Prefix:
First Name:ALEA
Middle Name:KAY
Last Name:OLSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W WACKER DR STE 1150
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1785
Mailing Address - Country:US
Mailing Address - Phone:312-878-8800
Mailing Address - Fax:312-448-9978
Practice Address - Street 1:720 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5806
Practice Address - Country:US
Practice Address - Phone:630-984-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL453713686Medicare PIN