Provider Demographics
NPI:1811530173
Name:MCCLANAHAN, MARY DENISE (RDN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DENISE
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DENISE
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:11864 W STATE HIGHWAY BB
Mailing Address - Street 2:
Mailing Address - City:WALNUT GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65770-8317
Mailing Address - Country:US
Mailing Address - Phone:858-997-9822
Mailing Address - Fax:
Practice Address - Street 1:1235 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2203
Practice Address - Country:US
Practice Address - Phone:417-820-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered