Provider Demographics
NPI:1558924910
Name:MAXWELL, CASSANDRA LEIGH (RD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEIGH
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10357 W 52ND PL UNIT 211
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6635
Mailing Address - Country:US
Mailing Address - Phone:574-971-1982
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9583
Practice Address - Country:US
Practice Address - Phone:303-673-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86055091133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered