Provider Demographics
NPI:1134687593
Name:O'CALLAHAN, ELENA LIN (RD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:LIN
Last Name:O'CALLAHAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:LIN
Other - Last Name:LOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2003 NW 57TH ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5532
Mailing Address - Country:US
Mailing Address - Phone:419-973-6589
Mailing Address - Fax:
Practice Address - Street 1:2930 MAPLE ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3832
Practice Address - Country:US
Practice Address - Phone:425-261-1500
Practice Address - Fax:425-261-1515
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60894926133V00000X
86049760133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered