Provider Demographics
NPI:1639224280
Name:DOOLEY, KATHLEEN L (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:L
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36475 5 MILE RD
Mailing Address - Street 2:COMMUNITY OUTREACH DEPT.
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1971
Mailing Address - Country:US
Mailing Address - Phone:734-655-8956
Mailing Address - Fax:734-655-4254
Practice Address - Street 1:24 FRANK LLOYD WRIGHT DR.
Practice Address - Street 2:PO BOX 0446 LOBBY J
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106-0446
Practice Address - Country:US
Practice Address - Phone:734-747-6766
Practice Address - Fax:734-222-3100
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11832133V00000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION86320002Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER