Provider Demographics
NPI:1538780598
Name:STADICK, PENNY JEAN (HHP,CCAP, CNC, CH)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:JEAN
Last Name:STADICK
Suffix:
Gender:F
Credentials:HHP,CCAP, CNC, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1532
Mailing Address - Country:US
Mailing Address - Phone:480-766-2716
Mailing Address - Fax:
Practice Address - Street 1:420 6TH ST W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1532
Practice Address - Country:US
Practice Address - Phone:480-766-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No174H00000XOther Service ProvidersHealth Educator
No176B00000XOther Service ProvidersMidwife
No251G00000XAgenciesHospice Care, Community Based
No374J00000XNursing Service Related ProvidersDoula
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty