Provider Demographics
NPI:1407384019
Name:ELLIOTT, KATHERINE BROOKS (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BROOKS
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 E DURANT AVE
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2023
Mailing Address - Country:US
Mailing Address - Phone:804-347-0068
Mailing Address - Fax:
Practice Address - Street 1:929 E DURANT AVE
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2023
Practice Address - Country:US
Practice Address - Phone:804-347-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86108465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered