Healthcare Provider Details

I. General information

NPI: 1033443460
Provider Name (Legal Business Name): KIMBERLY MARIE DODDS-THOMPSON RDN, LD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 42ND AVE S
SAINT CLOUD MN
56301-6251
US

IV. Provider business mailing address

3290 42ND AVE S
SAINT CLOUD MN
56301-6251
US

V. Phone/Fax

Practice location:
  • Phone: 320-227-5000
  • Fax:
Mailing address:
  • Phone: 320-227-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2863
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: