Provider Demographics
NPI:1104042043
Name:RYCZAK, JOANNE (RD CDE LDN)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:RYCZAK
Suffix:
Gender:F
Credentials:RD CDE LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-1125
Mailing Address - Country:US
Mailing Address - Phone:570-383-5622
Mailing Address - Fax:570-383-5603
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:MID VALLEY HOSPITAL
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452
Practice Address - Country:US
Practice Address - Phone:570-383-5622
Practice Address - Fax:570-383-5603
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000809133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered