Healthcare Provider Details

I. General information

NPI: 1376564468
Provider Name (Legal Business Name): WENDY N STOCKS MS,RD,CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 LAPORTE AVE
VALPARAISO IN
46383-5860
US

IV. Provider business mailing address

641 DEER MEADOW TRL
VALPARAISO IN
46385-8920
US

V. Phone/Fax

Practice location:
  • Phone: 219-263-4741
  • Fax: 219-263-7144
Mailing address:
  • Phone: 219-465-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37000613A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: