Provider Demographics
NPI:1609343383
Name:SLIKKER, AMANDA BETH (RD/LD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:SLIKKER
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 2 BOX 10703
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0108
Mailing Address - Country:US
Mailing Address - Phone:152-053-8514
Mailing Address - Fax:
Practice Address - Street 1:FINKENSTR. 11
Practice Address - Street 2:
Practice Address - City:BECHHOFEN
Practice Address - State:RHINELAND PFALZ
Practice Address - Zip Code:66894
Practice Address - Country:DE
Practice Address - Phone:152-053-8514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered