Provider Demographics
NPI:1598373524
Name:STRUCK, KELLY ANN (MS, RDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:STRUCK
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TOPSAIL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-2262
Mailing Address - Country:US
Mailing Address - Phone:973-600-6711
Mailing Address - Fax:
Practice Address - Street 1:9 TOPSAIL DR
Practice Address - Street 2:
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849-2262
Practice Address - Country:US
Practice Address - Phone:973-600-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered