Laura Clark, R.D., L.D.
Individual provider Active NPI Registered Dietitian · Dover, OH
NPI 1366604241 · NPPES record last updated Jul 1, 2008
Key facts
- NPI
- 1366604241
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 5670 (OH)
- Practice address
- 659 Boulevard St
Dover, OH 44622-2026 - Phone
- (330) 343-3311
- NPI assigned
- Jul 1, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5670 | OH | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Union Hospital Association | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 5670 | OH | Yes |
Addresses
Primary practice location
659 Boulevard St
Dover, OH 44622-2026
Mailing address
659 Boulevard St
Dover, OH 44622-2026
Phone (330) 343-3311
Other providers in Dover, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.