Provider Demographics
NPI:1336457142
Name:SWIFT, KATHIE MADONNA (MS RD LDN)
Entity Type:Individual
Prefix:MS
First Name:KATHIE
Middle Name:MADONNA
Last Name:SWIFT
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 MOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7455
Mailing Address - Country:US
Mailing Address - Phone:413-822-8660
Mailing Address - Fax:
Practice Address - Street 1:248 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7445
Practice Address - Country:US
Practice Address - Phone:413-822-8660
Practice Address - Fax:413-464-0108
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA570133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered