Provider Demographics
NPI:1700684818
Name:BARTEAU, STACY KAY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:KAY
Last Name:BARTEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 STARKVILLE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-8513
Mailing Address - Country:US
Mailing Address - Phone:314-368-5324
Mailing Address - Fax:
Practice Address - Street 1:3221 STARKVILLE ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-8513
Practice Address - Country:US
Practice Address - Phone:314-368-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164009651133V00000X
MO2004032602133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered