Individual
STACY LUECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
11703 E SPRAGUE AVE STE C3, SPOKANE VALLEY, WA 99206-6129
(509) 921-6560
(509) 921-6551
Mailing address
4003 E FUNK AVE, SPOKANE, WA 99223-5356
(509) 921-6560
(509) 921-6551
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D100001230
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00851672
ADA NUMBER
WA
01
—
8261471
PROVIDER NUMBER
WA
05
—
9051731
—
WA
01
—
D100001230
WA CERTIFICATION NUMBER
WA
Enumeration date
06/19/2008
Last updated
06/19/2008
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