Provider Demographics
NPI:1215262142
Name:JEFFREY, KATIE S (RDN, CSSD, CDN, LDN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:S
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:RDN, CSSD, CDN, LDN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:S
Other - Last Name:JEFFREY-LUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:564 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-1614
Mailing Address - Country:US
Mailing Address - Phone:860-917-6131
Mailing Address - Fax:
Practice Address - Street 1:564 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-1614
Practice Address - Country:US
Practice Address - Phone:860-917-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000821133V00000X
133VN1501X
RILDN00616133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics