Provider Demographics
NPI:1740455104
Name:KLICK, BARBARA B (RD, MPH)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:KLICK
Suffix:
Gender:F
Credentials:RD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TYLER PL
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-3015
Mailing Address - Country:US
Mailing Address - Phone:617-543-8581
Mailing Address - Fax:
Practice Address - Street 1:40 TYLER PL
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-3015
Practice Address - Country:US
Practice Address - Phone:617-543-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0134217133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000719101Medicare PIN