Provider Demographics
NPI:1992066351
Name:GRASSMUCK, MALLORY MICHELLE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:MICHELLE
Last Name:GRASSMUCK
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:MICHELLE
Other - Last Name:BRATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:5440 W 110TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-279-0226
Mailing Address - Fax:913-273-5131
Practice Address - Street 1:5440 W 110TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-279-0226
Practice Address - Fax:913-273-5131
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2931133V00000X
KS1699133V00000X
MO2011034424133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered