Provider Demographics
NPI:1598510307
Name:RIVERS, KATHLEEN (CNS, LDN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 SNOWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2450
Mailing Address - Country:US
Mailing Address - Phone:808-439-9395
Mailing Address - Fax:
Practice Address - Street 1:4410 ARAPAHOE AVE STE 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1135
Practice Address - Country:US
Practice Address - Phone:720-315-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6385133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education