Individual
STACEY E BROUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
10007 KENNERLY RD, SUITE A, SAINT LOUIS, MO 63128-2179
(314) 776-7112
(314) 776-7114
Mailing address
PO BOX 29255, SAINT LOUIS, MO 63126-0255
(314) 776-7112
(314) 776-7114
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2008030030
MO
Other
Enumeration date
09/22/2008
Last updated
10/04/2012
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