Basic Information
| Provider Information | |||||||||
| NPI: | 1184129538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLEAN | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 N SENATE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462023297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179631616 | ||||||||
| FaxNumber: | 3179631621 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 W WASHINGTON ST RM W041 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462042763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179632035 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 37002432A | IN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.