Provider Demographics
NPI:1295830149
Name:SMITH, KATHRYN KJORSTAD (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:KJORSTAD
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 CRABTREE LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1107
Mailing Address - Country:US
Mailing Address - Phone:419-885-2781
Mailing Address - Fax:419-885-2781
Practice Address - Street 1:3333 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2426
Practice Address - Country:US
Practice Address - Phone:419-259-2000
Practice Address - Fax:419-259-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL 115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLD 115OtherBOARD OF DIETETICS LICENS