Provider Demographics
NPI:1740755636
Name:CLOUGH, ERIKA MARY (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:MARY
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 S 19TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1909
Mailing Address - Country:US
Mailing Address - Phone:253-573-1600
Mailing Address - Fax:253-573-1601
Practice Address - Street 1:3401 S 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1909
Practice Address - Country:US
Practice Address - Phone:253-573-1600
Practice Address - Fax:253-573-1601
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60296535133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60296535OtherWA STATE DEPARTMENT OF HEALTH
1045258OtherCOMMISSION ON DIETETIC REGISTRATION