Healthcare Provider Details

I. General information

NPI: 1639224280
Provider Name (Legal Business Name): KATHLEEN L DOOLEY RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRANK LLOYD WRIGHT DR. PO BOX 0446 LOBBY J
ANN ARBOR MI
48106-0446
US

IV. Provider business mailing address

36475 5 MILE RD COMMUNITY OUTREACH DEPT.
LIVONIA MI
48154-1971
US

V. Phone/Fax

Practice location:
  • Phone: 734-747-6766
  • Fax: 734-222-3100
Mailing address:
  • Phone: 734-655-8956
  • Fax: 734-655-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number11832
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: