Provider Demographics
NPI:1376734160
Name:CLAUSSEN, KATHY ANN (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:CLAUSSEN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:GRANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19910 SHADY OAKS RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-5004
Mailing Address - Country:US
Mailing Address - Phone:320-634-4940
Mailing Address - Fax:
Practice Address - Street 1:301 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3302
Practice Address - Country:US
Practice Address - Phone:320-231-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1576133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered