Healthcare Provider Details

I. General information

NPI: 1811530173
Provider Name (Legal Business Name): MARY DENISE MCCLANAHAN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY DENISE BENTON RDN

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

11864 W STATE HIGHWAY BB
WALNUT GROVE MO
65770-8317
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2000
  • Fax:
Mailing address:
  • Phone: 858-997-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: