Provider Demographics
NPI:1770033300
Name:MCCLENNING, ERIN (RD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCCLENNING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RACHEL
Other - Last Name:LATHROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 N 1ST ST
Mailing Address - Street 2:MAILBOX 92
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62781-0001
Mailing Address - Country:US
Mailing Address - Phone:217-788-3948
Mailing Address - Fax:
Practice Address - Street 1:701 N 1ST ST
Practice Address - Street 2:MAILBOX 92
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-0001
Practice Address - Country:US
Practice Address - Phone:217-788-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered