Provider Demographics
NPI:1700358611
Name:KRICK, HEATHER MARIE (RD, LDN, CBC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:KRICK
Suffix:
Gender:F
Credentials:RD, LDN, CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MILAN ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5793
Mailing Address - Country:US
Mailing Address - Phone:610-937-8574
Mailing Address - Fax:
Practice Address - Street 1:2140 MILAN ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5793
Practice Address - Country:US
Practice Address - Phone:610-937-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86069637133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered