MEDICARE: STEPHANIE RENEA DAWSON 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)

General Provider Information

NPI Number	:	1285277376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE RENEA DAWSON IBCLC

Provider Business Mailing Address
First Line	:	1342 SUNNYDELL FARM LN
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3001
Country	:	US
Telephone Number	:	859-797-1068
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4619
Country	:	US
Telephone Number	:	863-349-3824
Fax Number	:

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

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	12/15/2025

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