Provider Demographics
NPI:1821372723
Name:CLARAHAN, SUSAN (RD, LD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CLARAHAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CREEK VIEW CT
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-3372
Mailing Address - Country:US
Mailing Address - Phone:319-383-3029
Mailing Address - Fax:319-338-2199
Practice Address - Street 1:332 S LINN ST
Practice Address - Street 2:SUITE 27
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-1608
Practice Address - Country:US
Practice Address - Phone:319-383-3029
Practice Address - Fax:319-338-2199
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00749133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered