Provider Demographics
NPI:1932787439
Name:KLINNER, SALLY (MS RD LD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:KLINNER
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 HOMELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2233
Mailing Address - Country:US
Mailing Address - Phone:563-564-8299
Mailing Address - Fax:
Practice Address - Street 1:225 WILMINGTON W CHESTER PIKE STE 202
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9011
Practice Address - Country:US
Practice Address - Phone:646-876-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered