Provider Demographics
NPI:1942545298
Name:HACKENMUELLER, STACY (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HACKENMUELLER
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 1:620 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-1108
Mailing Address - Country:US
Mailing Address - Phone:509-249-0477
Mailing Address - Fax:509-877-6881
Practice Address - Street 1:620 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WAPATO
Practice Address - State:WA
Practice Address - Zip Code:98951-1108
Practice Address - Country:US
Practice Address - Phone:509-249-0477
Practice Address - Fax:509-877-6881
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60317263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered