Provider Demographics
NPI:1851529200
Name:KLEMM, MEGAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:KLEMM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MCCALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:100 STAHLHUT DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-5059
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:217-735-5323
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005060133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered