Provider Demographics
NPI:1124186689
Name:DYCKMAN, JULIE ANN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:DYCKMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HAMMOND HILL RD
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1585
Mailing Address - Country:US
Mailing Address - Phone:508-422-2439
Mailing Address - Fax:507-473-6251
Practice Address - Street 1:14 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3003
Practice Address - Country:US
Practice Address - Phone:508-422-2439
Practice Address - Fax:508-473-6251
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2360133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered