Basic Information
| Provider Information | |||||||||
| NPI: | 1568189652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPYCHALSKI | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 INDUSTRIAL LOOP | ||||||||
| Address2: | |||||||||
| City: | GREENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531292452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144234100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 ONONDAGA ST | ||||||||
| Address2: | |||||||||
| City: | SKANEATELES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131521313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157100080 | ||||||||
| FaxNumber: | 8443644235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2022 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 010720 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.