Provider Demographics
NPI:1396010666
Name:SUCKOW, JULIE (RD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SUCKOW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:E WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4231
Mailing Address - Country:US
Mailing Address - Phone:702-569-7782
Mailing Address - Fax:
Practice Address - Street 1:1737 N WENATCHEE AVE STE E
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1189
Practice Address - Country:US
Practice Address - Phone:702-569-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61514909133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered