Provider Demographics
NPI:1073062683
Name:HANUSCHAK, KATHLEEN M (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:HANUSCHAK
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SOUTH CEDAR CREST BOULEVARD
Mailing Address - Street 2:SODEXO ADMINISTRATION OFFICE
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6202
Mailing Address - Country:US
Mailing Address - Phone:610-402-7949
Mailing Address - Fax:610-402-7460
Practice Address - Street 1:1200 SOUTH CEDAR CREST BOULEVARD
Practice Address - Street 2:SODEXO ADMINISTRATION OFFICE
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-7949
Practice Address - Fax:610-402-7460
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001338133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKHANUSCHAKMedicaid