Provider Demographics
NPI:1912564998
Name:SPAIN, EMILY WOLF (RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WOLF
Last Name:SPAIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32850 MEADOW LARK WAY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5529
Mailing Address - Country:US
Mailing Address - Phone:216-410-3021
Mailing Address - Fax:
Practice Address - Street 1:21843 NORTON RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1252
Practice Address - Country:US
Practice Address - Phone:216-839-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4458133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty