Provider Demographics
NPI:1689864050
Name:WILLIAMS, KATHLEEN DENISE (RDCDN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RDCDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4610
Mailing Address - Country:US
Mailing Address - Phone:585-461-8759
Mailing Address - Fax:585-461-8682
Practice Address - Street 1:620 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4610
Practice Address - Country:US
Practice Address - Phone:585-461-8759
Practice Address - Fax:585-461-8682
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered