Provider Demographics
NPI:1639813462
Name:MADSEN, CASSIE (RD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:MADSEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1129 N 49TH AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2425
Mailing Address - Country:US
Mailing Address - Phone:507-271-0503
Mailing Address - Fax:
Practice Address - Street 1:1129 N 49TH AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2425
Practice Address - Country:US
Practice Address - Phone:507-271-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3159133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered