Provider Demographics
NPI:1750732905
Name:MITCHELL, KATHERINE ALYSE (RD, CSO, LD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALYSE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD, CSO, LD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CSO, LD
Mailing Address - Street 1:460 W 10TH AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-366-2127
Mailing Address - Fax:
Practice Address - Street 1:460 W 10TH AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-366-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 7959133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
985933OtherCOMMISSION ON DIETETIC REGISTRATION