Provider Demographics
NPI:1790334886
Name:CASSELLIUS, KATHRYN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CASSELLIUS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MAGNUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5555 QUAIL AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3254
Mailing Address - Country:US
Mailing Address - Phone:763-412-2823
Mailing Address - Fax:
Practice Address - Street 1:876 TIMBER DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4850
Practice Address - Country:US
Practice Address - Phone:919-803-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered