Healthcare Provider Details

I. General information

NPI: 1588247480
Provider Name (Legal Business Name): SAMANTHA SLAUGHTER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 HURLEY WAY STE 110
SACRAMENTO CA
95825-3299
US

IV. Provider business mailing address

4320 NARRAGANSET WAY
MATHER CA
95655-3037
US

V. Phone/Fax

Practice location:
  • Phone: 916-326-5835
  • Fax: 916-444-5494
Mailing address:
  • Phone: 916-600-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-23072
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: