Individual
MRS. KIMBERLY JO SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
1500 MEMORY LANE EXT, YORK, PA 17402-9601
(717) 757-5433
Mailing address
1500 MEMORY LANE EXT, YORK, PA 17402-9601
(717) 757-5433
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN004222
PA
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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