Individual
MRS. KATIE MARIE LICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
3525 MONTEREY DR, ST LOUIS PARK, MN 55416-5275
(952) 993-5161
Mailing address
3525 MONTEREY DR, ST LOUIS PARK, MN 55416-5275
(952) 993-5161
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2650
MN
Other
Enumeration date
12/10/2007
Last updated
01/10/2011
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