| Organization Name: | CLEAN SLATE NUTRITION |
| NPI Number: | 1619344157 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PEGGYC COSGROVE (DIETITIAN/OWNER) |
| Mailing Address: | 709 N Buchanan St Little Rock |
| State: | AR US |
| Postal Code: | 722053264 |
| Phone Number: | 5015800295 |
| Fax Number: | |
| NPI Enumeration Date: | 09/01/2015 |
| NPI Last Update Date: | 09/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 1005772 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |