Provider Demographics
NPI:1649573114
Name:CLOUTIER, CAITLIN MARIE (RD)
Entity type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:MARIE
Last Name:CLOUTIER
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 1:6507 FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1294
Mailing Address - Country:US
Mailing Address - Phone:317-506-4539
Mailing Address - Fax:
Practice Address - Street 1:6507 FERGUSON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1294
Practice Address - Country:US
Practice Address - Phone:317-506-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1037370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered