Provider Demographics
NPI:1649529645
Name:GOSSELIN, KATHRYN (RD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:287 MAIN ST
Mailing Address - Street 2:STE. 301
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7054
Mailing Address - Country:US
Mailing Address - Phone:207-795-7520
Mailing Address - Fax:207-795-7170
Practice Address - Street 1:287 MAIN ST
Practice Address - Street 2:STE. 301
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7054
Practice Address - Country:US
Practice Address - Phone:207-795-7520
Practice Address - Fax:207-795-7170
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED1948133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered