Provider Demographics
NPI:1780282848
Name:DOWD, KATIE ANNE (NDTR, CLC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANNE
Last Name:DOWD
Suffix:
Gender:F
Credentials:NDTR, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 OAK NECK RD
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-3619
Mailing Address - Country:US
Mailing Address - Phone:631-210-6362
Mailing Address - Fax:
Practice Address - Street 1:712 OAK NECK RD
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-3619
Practice Address - Country:US
Practice Address - Phone:631-774-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86041153136A00000X
NY321998174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered