Provider Demographics
NPI:1982023511
Name:HAGGERTY, STEPHANIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1436
Mailing Address - Country:US
Mailing Address - Phone:907-500-4608
Mailing Address - Fax:
Practice Address - Street 1:1601 SALMON CREEK LN
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7867
Practice Address - Country:US
Practice Address - Phone:907-586-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered