Provider Demographics
NPI:1386107852
Name:BADGER, KATIE A (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:BADGER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:MINDESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 CHELMSFORD STREET STE 7
Mailing Address - Street 2:#1054
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824
Mailing Address - Country:US
Mailing Address - Phone:978-764-0968
Mailing Address - Fax:
Practice Address - Street 1:83 PARKHURST RD STE 12
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1500
Practice Address - Country:US
Practice Address - Phone:978-764-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered