Basic Information
| Provider Information | |||||||||
| NPI: | 1528298205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLICKNER-GARVEY | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 S WESTFIELD ST | ||||||||
| Address2: | |||||||||
| City: | FEEDING HILLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010302702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137862957 | ||||||||
| FaxNumber: | 4137862977 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 S WESTFIELD ST | ||||||||
| Address2: | |||||||||
| City: | FEEDING HILLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010302702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137862957 | ||||||||
| FaxNumber: | 4137862977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2009 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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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 | 914 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.