Provider Demographics
NPI:1538611819
Name:DENNIS, KATELIN MARIE (RD, CSP)
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:MARIE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:RD, CSP
Other - Prefix:
Other - First Name:KATELIN
Other - Middle Name:MARIE
Other - Last Name:SCHROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CSP
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:MAIL CODE: 5891
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-460-4366
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:MAIL CODE: 5891
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-460-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1045026133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric