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General NPI Number Information
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NPI Number | 1235327453
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Entity Type | Individual
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Provider Name | STACIA ANNE CLINTON RD.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 500 FRANKLIN VILLAGE DR SUITE 106
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City | FRANKLIN
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State | MA
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Zip | 02038-4017
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Country | US
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Telephone | 860-798-8645
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Fax |
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Provider Business Mailing Address
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Address Line | 51 ALFRED DR
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City | TOLLAND
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State | CT
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Zip | 06084-3140
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Country | US
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Telephone | 860-798-8645
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | NU 2590
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License Number State | MA
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