MEDICARE: CASSANDRA ELLEN ROBISON RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	971496	UT

General Provider Information

NPI Number	:	1174452130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA ELLEN ROBISON RD

Provider Business Mailing Address
First Line	:	1280 E 5850 S APT 5
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-4930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 E 5850 S APT 5
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-4930
Country	:	US
Telephone Number	:	801-628-3761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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