Provider Demographics
NPI:1275263659
Name:STACKHOUSE, AMY (RDN, CN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:STACKHOUSE
Suffix:
Gender:F
Credentials:RDN, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 NW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3325
Mailing Address - Country:US
Mailing Address - Phone:206-854-0431
Mailing Address - Fax:
Practice Address - Street 1:3258 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3325
Practice Address - Country:US
Practice Address - Phone:206-854-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61288814133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered