Provider Demographics
NPI:1760882658
Name:NIEDERT, KATHLEEN (PHD, RD, CSG, LD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NIEDERT
Suffix:
Gender:F
Credentials:PHD, RD, CSG, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ARDIS ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IA
Mailing Address - Zip Code:50643-9778
Mailing Address - Country:US
Mailing Address - Phone:319-240-4636
Mailing Address - Fax:319-277-5158
Practice Address - Street 1:420 E 11TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-3364
Practice Address - Country:US
Practice Address - Phone:319-222-2040
Practice Address - Fax:319-277-5158
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00058133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered