MEDICARE: ALISON HAZELBAKER PHD, IBCLC, CST

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	:	1295944528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON HAZELBAKER PHD, IBCLC, CST

Provider Business Mailing Address
First Line	:	5115 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-3413
Country	:	US
Telephone Number	:	614-326-3504
Fax Number	:	614-326-3509

Provider Business Practice Location Address
First Line	:	5115 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-3413
Country	:	US
Telephone Number	:	614-326-3504
Fax Number	:	614-326-3509

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	11/09/2015

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