Provider Demographics
NPI:1669765566
Name:SKEBA, STEPHANIE STARCK (RD, LD, CPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:STARCK
Last Name:SKEBA
Suffix:
Gender:F
Credentials:RD, LD, CPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:STARCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 FORD ROAD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:630-670-7116
Mailing Address - Fax:
Practice Address - Street 1:1825 WOODWINDS DR
Practice Address - Street 2:WAYS TO WELLNESS
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55125-2202
Practice Address - Country:US
Practice Address - Phone:651-232-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2946133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered