Provider Demographics
NPI:1194566216
Name:SPEELMAN, KATHRYN (RD, RDN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SPEELMAN
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:SPEELMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, RDN
Mailing Address - Street 1:973 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6162
Mailing Address - Country:US
Mailing Address - Phone:732-619-4236
Mailing Address - Fax:
Practice Address - Street 1:175 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-3212
Practice Address - Country:US
Practice Address - Phone:732-341-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered