Provider Demographics
NPI:1073958138
Name:COOLEY, KRISTI M (RD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:M
Last Name:COOLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:M
Other - Last Name:CIESLEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:824 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3112
Mailing Address - Country:US
Mailing Address - Phone:715-342-7500
Mailing Address - Fax:
Practice Address - Street 1:824 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3112
Practice Address - Country:US
Practice Address - Phone:715-342-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI514133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI514-29OtherWI STATE LIC