Provider Demographics
NPI:1417120239
Name:HARRISON, CLANCY CASH (RD)
Entity Type:Individual
Prefix:MRS
First Name:CLANCY
Middle Name:CASH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 RICE CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1424
Mailing Address - Country:US
Mailing Address - Phone:570-881-0683
Mailing Address - Fax:
Practice Address - Street 1:27 RICE CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1424
Practice Address - Country:US
Practice Address - Phone:570-881-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003796133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered