Provider Demographics
NPI:1427609452
Name:SCHOOLER, KELLY RAE (RDN, CDE)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:RAE
Last Name:SCHOOLER
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RAE
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CDE
Mailing Address - Street 1:23530 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2283
Mailing Address - Country:US
Mailing Address - Phone:734-748-3152
Mailing Address - Fax:
Practice Address - Street 1:18544 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4194
Practice Address - Country:US
Practice Address - Phone:248-569-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1054573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered