| Doctor Name: | ALICIA D SUSILLA |
| NPI Number: | 1154315968 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS |
| License Number: | DI00001601 |
| Business Practice Address: | 600 Broadway St Longview, WA - 986323256 |
| Business Phone Number: | 3604142200 |
| Business Fax Number: | 3604142210 |
| Mailing Address: | Po Box 249, LONGVIEW |
| State: | WA |
| Postal Code: | 986327154 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/07/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | DI00001601 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |