Provider Demographics
NPI:1710384243
Name:MUELLER, KAITLIN (RD, CDCES)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 4399
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4399
Mailing Address - Country:US
Mailing Address - Phone:503-660-8750
Mailing Address - Fax:
Practice Address - Street 1:10175 SW BARBUR BLVD STE 300BM
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5909
Practice Address - Country:US
Practice Address - Phone:503-660-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60366844133V00000X
OR10177728133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered