Provider Demographics
NPI:1841584554
Name:TIMLICK, STEPHANIE (RD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TIMLICK
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 1:1297 BURNS WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3166
Mailing Address - Country:US
Mailing Address - Phone:406-751-5454
Mailing Address - Fax:406-756-2716
Practice Address - Street 1:1297 BURNS WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3166
Practice Address - Country:US
Practice Address - Phone:406-751-5454
Practice Address - Fax:406-756-2716
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered