Provider Demographics
NPI:1275392300
Name:RIVARD, CASSANDRA LEE (RD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:RIVARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 ANN ARBOR RD W
Mailing Address - Street 2:PMB 1436
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170
Mailing Address - Country:US
Mailing Address - Phone:313-583-9991
Mailing Address - Fax:
Practice Address - Street 1:1098 ANN ARBOR RD W
Practice Address - Street 2:PMB 1436
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:313-583-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86082200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered