Provider Demographics
NPI:1235181009
Name:SCANLON, CATHERINE BURTTSCHELL (MS RD LD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BURTTSCHELL
Last Name:SCANLON
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:LYNESE
Other - Last Name:BURTTSCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2460 E GERMANN RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1572
Mailing Address - Country:US
Mailing Address - Phone:480-883-1188
Mailing Address - Fax:480-883-1193
Practice Address - Street 1:2460 E GERMANN RD
Practice Address - Street 2:SUITE 18
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1572
Practice Address - Country:US
Practice Address - Phone:480-883-1188
Practice Address - Fax:480-883-1193
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01703133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17759Medicare PIN