Provider Demographics
NPI:1669628723
Name:MOLLOY, CATHLEEN RENEE (RD)
Entity Type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:RENEE
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 738
Mailing Address - Street 2:340 PEAK ONE DR.
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-0738
Mailing Address - Country:US
Mailing Address - Phone:970-668-6902
Mailing Address - Fax:970-668-9578
Practice Address - Street 1:340 PEAK ONE DR.
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-6902
Practice Address - Fax:970-668-9578
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered