Provider Demographics
NPI:1346839354
Name:TEAGUE, ERIN ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:JENKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:212 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1417
Mailing Address - Country:US
Mailing Address - Phone:216-224-4900
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE # LKSD1500
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-1617
Practice Address - Fax:216-844-7497
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0987662OtherREGISTERED DIETITIAN NUMBER
OH6287OtherDIETITIAN LICENSE