Provider Demographics
NPI:1376564468
Name:STOCKS, WENDY N (MS,RD,CD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:N
Last Name:STOCKS
Suffix:
Gender:F
Credentials:MS,RD,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 DEER MEADOW TRL
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8920
Mailing Address - Country:US
Mailing Address - Phone:219-465-6226
Mailing Address - Fax:
Practice Address - Street 1:814 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5860
Practice Address - Country:US
Practice Address - Phone:219-263-4741
Practice Address - Fax:219-263-7144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000613A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered