Individual
MRS. STACEY KOEKKOEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS RD, LDN, LMHC
Contact information
Practice address
260 BOSTON POST RD, WAYLAND, MA 01778-1889
(508) 276-1743
Mailing address
260 BOSTON POST RD, SUITE 11, WAYLAND, MA 01778-1889
(508) 276-1743
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2606
MA
Other
Enumeration date
08/30/2007
Last updated
04/04/2017
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