Provider Demographics
NPI:1821620162
Name:JOSEPH, KAITLYNN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MONUMENT RD STE 207
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1725
Mailing Address - Country:US
Mailing Address - Phone:800-203-8657
Mailing Address - Fax:800-258-1426
Practice Address - Street 1:150 MONUMENT RD STE 207
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1725
Practice Address - Country:US
Practice Address - Phone:800-203-8657
Practice Address - Fax:800-258-1426
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8596133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty