Provider Demographics
NPI:1821855800
Name:CLEMENS, MADISON (RDN, LD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 E SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1817
Mailing Address - Country:US
Mailing Address - Phone:515-695-3276
Mailing Address - Fax:
Practice Address - Street 1:2150 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1817
Practice Address - Country:US
Practice Address - Phone:515-695-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered