Basic Information
| Provider Information | |||||||||
| NPI: | 1639224280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOOLEY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36475 5 MILE RD | ||||||||
| Address2: | COMMUNITY OUTREACH DEPT. | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481541971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346558956 | ||||||||
| FaxNumber: | 7346554254 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 FRANK LLOYD WRIGHT DR. | ||||||||
| Address2: | PO BOX 0446 LOBBY J | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481060446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347476766 | ||||||||
| FaxNumber: | 7342223100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 11832 | MI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133NN1002X | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
No ID Information.