Provider Demographics
NPI:1699284323
Name:CLEMENS, MARLEE BROADRICK (RDN,LDN)
Entity type:Individual
Prefix:
First Name:MARLEE
Middle Name:BROADRICK
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 3RD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2153
Mailing Address - Country:US
Mailing Address - Phone:423-265-2273
Mailing Address - Fax:
Practice Address - Street 1:1000 E 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2153
Practice Address - Country:US
Practice Address - Phone:423-265-2273
Practice Address - Fax:423-648-9935
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered