Provider Demographics
NPI:1477854404
Name:THOMPSON, KAITLIN ILEEN (RD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ILEEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ILEEN
Other - Last Name:CLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1655 BEAM AVE
Mailing Address - Street 2:#330
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1163
Mailing Address - Country:US
Mailing Address - Phone:651-227-6351
Mailing Address - Fax:651-227-1134
Practice Address - Street 1:1655 BEAM AVE
Practice Address - Street 2:#330
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1163
Practice Address - Country:US
Practice Address - Phone:651-227-6351
Practice Address - Fax:651-227-1134
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered