MEDICARE: ASHLEY BENZ LACTATION CONSULTANT, LLC

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	:	1437818895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEY BENZ LACTATION CONSULTANT, LLC

Provider Business Mailing Address
First Line	:	9302 NEW LA GRANGE RD STE D
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40242-3652
Country	:	US
Telephone Number	:	502-417-3769
Fax Number	:

Provider Business Practice Location Address
First Line	:	9302 NEW LA GRANGE RD STE D
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40242-3652
Country	:	US
Telephone Number	:	502-417-3769
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY ASHLEY BENZ
Credential	:	IBCLC
Telephone Number	:	502-417-3769

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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