Provider Demographics
NPI:1942829320
Name:BEALE, CHELSEA CATHLEEN (RD)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:CATHLEEN
Last Name:BEALE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:CHELSEA
Other - Middle Name:CATHLEEN
Other - Last Name:BEALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1616 WOOD POINTE LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3380
Mailing Address - Country:US
Mailing Address - Phone:989-708-2867
Mailing Address - Fax:
Practice Address - Street 1:427 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-1980
Practice Address - Country:US
Practice Address - Phone:989-708-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86089832133VN1101X, 133VN1201X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management