Provider Demographics
NPI:1356399125
Name:DIAL, KATHLEEN SUSAN (RD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:DIAL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:SUSAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7236 E SABINO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-2217
Mailing Address - Country:US
Mailing Address - Phone:520-792-1450
Mailing Address - Fax:520-629-4691
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:NUTRITION & FOOD SERVICE (5-120)
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:520-629-4691
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ368621133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered