Provider Demographics
NPI:1952865941
Name:KLAG, ERICA LEE (RD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEE
Last Name:KLAG
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 1:1 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1520
Mailing Address - Country:US
Mailing Address - Phone:508-333-7654
Mailing Address - Fax:
Practice Address - Street 1:1 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-1520
Practice Address - Country:US
Practice Address - Phone:508-333-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered