Provider Demographics
NPI:1144473810
Name:SNYDER, KATHERINE (RD, LD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 SE SUNNYSIDE ROAD
Mailing Address - Street 2:KSMC NUTRITION SERVICES
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9303
Mailing Address - Country:US
Mailing Address - Phone:503-571-4876
Mailing Address - Fax:503-571-6314
Practice Address - Street 1:10180 SE SUNNYSIDE ROAD
Practice Address - Street 2:KSMC NUTRITION SERVICES
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9303
Practice Address - Country:US
Practice Address - Phone:503-571-4876
Practice Address - Fax:503-571-6314
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR849133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered