Provider Demographics
NPI:1699891598
Name:STEHLY, MARY
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:STEHLY
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:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:HECLA
Mailing Address - State:SD
Mailing Address - Zip Code:57446-0007
Mailing Address - Country:US
Mailing Address - Phone:605-225-1538
Mailing Address - Fax:605-229-2053
Practice Address - Street 1:1315 6TH AVE SE
Practice Address - Street 2:SUITE 6
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4900
Practice Address - Country:US
Practice Address - Phone:605-225-1538
Practice Address - Fax:605-229-2053
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0039133N00000X
SD15003133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350183Medicaid
SD5350180Medicaid
SD5350182Medicaid