Active NPI
Alissa Fay Bedtke, LDN
- Registered Dietitian
- Oak Lawn, IL
National Provider Identifier
1194429316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.008702
- Practice address
- 4440 W 95TH St
Oak Lawn, IL 60453-2600 - Phone
- (708) 684-3001
- NPI assigned
- Mar 30, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.008702 | IL | Primary |
Addresses
Primary practice location
4440 W 95TH St
Oak Lawn, IL 60453-2600
Mailing address
6534 N Northwest Hwy Apt 3C
Chicago, IL 60631-1448
Phone (773) 401-1833
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.008702 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1194429316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6534 N NORTHWEST HWY APT 3C",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606311448",
"telephone_number": "773-401-1833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4440 W 95TH ST",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604532600",
"telephone_number": "708-684-3001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEDTKE",
"first_name": "ALISSA",
"middle_name": "FAY",
"credential": "LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-30",
"last_updated": "2023-03-30",
"certification_date": "2023-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.008702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Lawn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.