Provider Demographics
NPI:1114815149
Name:GLOSCHAT, KASIE (MS, CD, RD)
Entity type:Individual
Prefix:
First Name:KASIE
Middle Name:
Last Name:GLOSCHAT
Suffix:
Gender:F
Credentials:MS, CD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 W 1600 S
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-1600
Mailing Address - Country:US
Mailing Address - Phone:406-212-9116
Mailing Address - Fax:
Practice Address - Street 1:165 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2990
Practice Address - Country:US
Practice Address - Phone:801-213-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12348711-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered