Provider Demographics
NPI:1558405027
Name:KINDBLADE, BEVERLY DIANNE (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DIANNE
Last Name:KINDBLADE
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:DIANNE
Other - Last Name:ROCKHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1904 3RD AVE
Mailing Address - Street 2:SUITE 935
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1191
Mailing Address - Country:US
Mailing Address - Phone:206-920-7676
Mailing Address - Fax:206-724-0574
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:SUITE 935
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1191
Practice Address - Country:US
Practice Address - Phone:206-920-7676
Practice Address - Fax:206-724-0574
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000649133V00000X
IL717636133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered