Provider Demographics
NPI:1659121432
Name:BENJAMIN, KAITLIN ANNE (MPH, RD, CD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANNE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MPH, RD, CD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ANNE
Other - Last Name:SICKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7311 33RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5910
Mailing Address - Country:US
Mailing Address - Phone:240-925-3755
Mailing Address - Fax:
Practice Address - Street 1:8301B 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4118
Practice Address - Country:US
Practice Address - Phone:206-228-6961
Practice Address - Fax:206-866-0204
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86289883133N00000X
WADI61376966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist