Healthcare Provider Details

I. General information

NPI: 1588088181
Provider Name (Legal Business Name): BRECK MARIE MATTESON RN BSN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6356 S NEWLAND CT
LITTLETON CO
80123-3862
US

IV. Provider business mailing address

5570 PRESERVE DR
GREENWOOD VILLAGE CO
80121-2111
US

V. Phone/Fax

Practice location:
  • Phone: 720-463-4016
  • Fax:
Mailing address:
  • Phone: 248-506-7474
  • Fax: 248-506-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number4704261958
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN.0180116
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: