Provider Demographics
NPI:1518335306
Name:DEIGHTON, KATALEE (RDN)
Entity Type:Individual
Prefix:
First Name:KATALEE
Middle Name:
Last Name:DEIGHTON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14997 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4051
Mailing Address - Country:US
Mailing Address - Phone:734-968-3599
Mailing Address - Fax:
Practice Address - Street 1:4900 MERCURY DR
Practice Address - Street 2:STE. 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2947
Practice Address - Country:US
Practice Address - Phone:313-982-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1062441133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered