MEDICARE: RONDA LYNN SPENCER-STREETER IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-108388

General Provider Information

NPI Number	:	1164276424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONDA LYNN SPENCER-STREETER IBCLC

Provider Business Mailing Address
First Line	:	173 N MONROE ST
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-1021
Country	:	US
Telephone Number	:	989-423-4083
Fax Number	:

Provider Business Practice Location Address
First Line	:	173 N MONROE ST
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-1021
Country	:	US
Telephone Number	:	989-423-4083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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