Individual
MRS. SHANNON MOONEY WICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN, CSOWM
Contact information
Practice address
72 MAIN ST, KENNEBUNK, ME 04043-7021
(207) 467-8825
(207) 467-8811
Mailing address
72 MAIN ST, KENNEBUNK, ME 04043-7021
(207) 467-8825
(207) 467-8811
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
2439
MA
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
Primary
DI1082
ME
Other
Enumeration date
10/20/2006
Last updated
07/24/2023
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