Stacey Koekkoek, MS RD, LDN, LMHC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2606 Issued in MA

Practice address

260 Boston Post Rd
Wayland, MA 01778-1889

Phone

(508) 276-1743

NPI assigned

Aug 30, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 7, 2024 through Oct 7, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stacey Koekkoek

  • Mental Health Counselor
  • Wayland, MA
  • NPI 1316364375
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491264000000",
    "number": "1982898177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 BOSTON POST RD",
            "address_2": "SUITE 11",
            "city": "WAYLAND",
            "state": "MA",
            "postal_code": "017781889",
            "telephone_number": "508-276-1743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 BOSTON POST RD",
            "city": "WAYLAND",
            "state": "MA",
            "postal_code": "017781889",
            "telephone_number": "508-276-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEKKOEK",
        "first_name": "STACEY",
        "name_prefix": "Mrs.",
        "credential": "MS RD, LDN, LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2017-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "2606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Boyle
• Audrey Sarah Kern, D.M.D.
• Kiersten Anderson
• Lynne Marie King, P.T.
• Diana Kisel, FNP-C
• Yong-Han Koo, D.D.S.
• Alyssa Krieger, MSN, NP-BC
• Jonathan S Krochmal, DDS
• Paula Jean Kweder, P.T.
• Erica L Landry, MS CCC-SLP

• Registered Dietitian in Wayland, MA
• Providers in Wayland, MA by specialty
• Registered Dietitian in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.