Provider Demographics
NPI:1710533369
Name:MCCLELLAN, LINDA (RDN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 W 1750 N
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-9723
Mailing Address - Country:US
Mailing Address - Phone:801-669-0862
Mailing Address - Fax:
Practice Address - Street 1:150 W 100 N
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2036
Practice Address - Country:US
Practice Address - Phone:435-789-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL570233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered