Provider Demographics
NPI:1700583077
Name:HARRIOTT, RALEIGH MCCLAIN (RDN, LD, CLC)
Entity Type:Individual
Prefix:
First Name:RALEIGH
Middle Name:MCCLAIN
Last Name:HARRIOTT
Suffix:
Gender:F
Credentials:RDN, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 HARRISON POND DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8887
Mailing Address - Country:US
Mailing Address - Phone:614-309-1464
Mailing Address - Fax:
Practice Address - Street 1:372-38 HAPJEONG-DONG MAPO-GU
Practice Address - Street 2:401
Practice Address - City:SEOUL
Practice Address - State:SOUTH KOREA
Practice Address - Zip Code:04071
Practice Address - Country:KR
Practice Address - Phone:010-997-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08227133V00000X
OHALPP-318888174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered