Provider Demographics
NPI:1518750157
Name:VAN VLIET, KATIE (NTP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:VAN VLIET
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9576
Mailing Address - Country:US
Mailing Address - Phone:209-596-0744
Mailing Address - Fax:
Practice Address - Street 1:3519 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9576
Practice Address - Country:US
Practice Address - Phone:209-596-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist