Provider Demographics
NPI:1427872373
Name:LOESCH, CAITLYN MICHELLE (RD, CDN)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MICHELLE
Last Name:LOESCH
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:MICHELLE
Other - Last Name:HARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:
Practice Address - Street 1:1783 ROUTE 9 STE 101
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-2467
Practice Address - Country:US
Practice Address - Phone:518-881-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered