Provider Demographics
NPI:1699372912
Name:WOLFFE, KELLY (RDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WOLFFE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 NE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6524
Mailing Address - Country:US
Mailing Address - Phone:925-788-7219
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6729
Practice Address - Fax:206-223-6472
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2023-05-18
Deactivation Date:2020-10-12
Deactivation Code:
Reactivation Date:2020-11-18
Provider Licenses
StateLicense IDTaxonomies
WA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered