Individual
MARY JO MCCLINTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-9568
(812) 353-9318
Mailing address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-9568
(812) 353-9318
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37000725A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37000725A
STATE LICENSE
IN
Enumeration date
05/08/2007
Last updated
07/08/2007
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