Provider Demographics
NPI:1932326295
Name:MCCLIMENT, COURTNEY A (RD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:MCCLIMENT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:A
Other - Last Name:TOFELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:BOX 359790
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-731-3131
Mailing Address - Fax:206-731-8540
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX 359790
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-731-3131
Practice Address - Fax:206-731-8540
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ48244Medicare UPIN