Provider Demographics
NPI:1184225757
Name:WACKER, ALEAHA LYNN (RD, LDN)
Entity type:Individual
Prefix:MISS
First Name:ALEAHA
Middle Name:LYNN
Last Name:WACKER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ROCKY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-4535
Mailing Address - Country:US
Mailing Address - Phone:570-390-9939
Mailing Address - Fax:
Practice Address - Street 1:95 ROCKY VIEW DR
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-4535
Practice Address - Country:US
Practice Address - Phone:570-390-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered