Provider Demographics
NPI:1245853837
Name:LAVENDER, KAILEY (MS, RD, CD)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:LAVENDER
Suffix:
Gender:
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 OCCIDENTAL AVE S UNIT 406
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-6825
Mailing Address - Country:US
Mailing Address - Phone:765-702-4654
Mailing Address - Fax:
Practice Address - Street 1:19399 114TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-0033
Practice Address - Country:US
Practice Address - Phone:765-702-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered