Individual
MRS. SUZANNE CAROL ICKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., LDN
Contact information
Practice address
2545 SCHOENERSVILLE RD, LEHIGHVALLEY HOSPITAL -CLINICAL NUTRITION, BETHLEHEM, PA 18017-7300
(484) 788-1255
Mailing address
45 WARWICK ST, SUITE 100, BETHLEHEM, PA 18018-2431
(484) 788-1255
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN001762
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001793520
HIGHMARK BLUE SHIELD FOR FEDERAL EMPLOYEES
PA
01
—
001793520000
AMERIHEALTH
PA
01
—
055154
MEDICARE PROVIDER NUMBER
PA
01
—
2624640
AETNA US HEALTHCARE
PA
01
—
2630546000
INDEPENDENCE BLUE CROSS
PA
Enumeration date
05/20/2007
Last updated
09/28/2016
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