Provider Demographics
NPI:1922510593
Name:MASON, KAITLYN GALE (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:GALE
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:GALE
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16045 1ST AVE S FL 1
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1401
Mailing Address - Country:US
Mailing Address - Phone:206-965-4100
Mailing Address - Fax:206-965-4119
Practice Address - Street 1:16045 1ST AVE S FL 1
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1401
Practice Address - Country:US
Practice Address - Phone:206-965-4100
Practice Address - Fax:206-965-4119
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60803909133VN1005X
WA60803909133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal