Provider Demographics
NPI:1487308441
Name:COLLING, KATELYN MARGARET
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARGARET
Last Name:COLLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22204 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1240
Mailing Address - Country:US
Mailing Address - Phone:586-601-5122
Mailing Address - Fax:
Practice Address - Street 1:22204 MARTIN RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1240
Practice Address - Country:US
Practice Address - Phone:586-601-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist