Healthcare Provider Details

I. General information

NPI: 1871268045
Provider Name (Legal Business Name): MICHELLE MARIE BEUTEL IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 N SAN JOAQUIN ST
STOCKTON CA
95202-1426
US

IV. Provider business mailing address

1230 N SAN JOAQUIN ST
STOCKTON CA
95202-1426
US

V. Phone/Fax

Practice location:
  • Phone: 209-756-4058
  • Fax:
Mailing address:
  • Phone: 209-756-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL-12018
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-12018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: