Provider Demographics
NPI:1205149184
Name:CLAY, KATHLEEN S (RD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:CLAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2956
Mailing Address - Country:US
Mailing Address - Phone:269-385-2784
Mailing Address - Fax:269-385-2321
Practice Address - Street 1:3048 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2956
Practice Address - Country:US
Practice Address - Phone:269-385-2784
Practice Address - Fax:269-385-2321
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered