Provider Demographics
NPI:1245513126
Name:WEINHOLD, KELSEY TATE (RD, CD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:TATE
Last Name:WEINHOLD
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 SW ADMIRAL WAY
Mailing Address - Street 2:#203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2444
Mailing Address - Country:US
Mailing Address - Phone:612-481-3477
Mailing Address - Fax:
Practice Address - Street 1:901 AUBURN WAY N
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4100
Practice Address - Country:US
Practice Address - Phone:206-296-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1013615133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered