Healthcare Provider Details

I. General information

NPI: 1598116634
Provider Name (Legal Business Name): KATHERINE MCCLEAN LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LINDEN ST APT D
FRAMINGHAM MA
01702
US

IV. Provider business mailing address

19 LINDEN ST APT D
FRAMINGHAM MA
01702
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-6157
  • Fax:
Mailing address:
  • Phone: 508-879-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number3188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: