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NPI Code Detail

MEDICARE: AMANDA J CHALICH IBCLC LM LMT

MEDICARE: AMANDA J CHALICH IBCLC LM LMT
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
1176B00000XMidwife99129TX

General Provider Information

NPI Number : 1174804165
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA J CHALICH IBCLC LM LMT
Provider Business Mailing Address
First Line : 8214 MC KAMY DR
Second Line :
City : AUSTIN
State : TX
Zip : 78744-5926
Country : US
Telephone Number : 512-909-2290
Fax Number :
Provider Business Practice Location Address
First Line : 111 RAMBLE LN STE 115
Second Line :
City : AUSTIN
State : TX
Zip : 78745-2281
Country : US
Telephone Number : 512-808-0237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2011
Last Update Date : 02/08/2022

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