Basic Information
| Provider Information | |||||||||
| NPI: | 1396063889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUSER | ||||||||
| FirstName: | TALIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICENSED DIETICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 ELM ST | ||||||||
| Address2: | STE 4360 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752014701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477232210 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1775 DEMPSTER ST | ||||||||
| Address2: | ADVOCATE LUTHERAN GENERAL HOSPITAL | ||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477232210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2010 | ||||||||
| LastUpdateDate: | 04/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 164005073 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 164005073 | 01 | IL | STATE OF IL DIETITIAN LICENSE | OTHER |