Provider Demographics
NPI:1740584721
Name:DANFORTH, KASEY L (MED, RD, LD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:L
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:MED, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0863
Mailing Address - Country:US
Mailing Address - Phone:207-745-3886
Mailing Address - Fax:
Practice Address - Street 1:2020 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0863
Practice Address - Country:US
Practice Address - Phone:207-745-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1054133V00000X
PADN0043133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered