Provider Demographics
NPI:1912790585
Name:GRAVES, ALLYSON (RD, LDN, MPH)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RD, LDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 N ASHLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-8569
Mailing Address - Country:US
Mailing Address - Phone:434-409-9044
Mailing Address - Fax:
Practice Address - Street 1:4913 N ASHLAND AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-8569
Practice Address - Country:US
Practice Address - Phone:434-409-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.011673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered