Healthcare Provider Details

I. General information

NPI: 1285277376
Provider Name (Legal Business Name): STEPHANIE RENEA DAWSON IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S FLORIDA AVE
LAKELAND FL
33801-4619
US

IV. Provider business mailing address

1342 SUNNYDELL FARM LN
LAKELAND FL
33809-3001
US

V. Phone/Fax

Practice location:
  • Phone: 863-349-3824
  • Fax:
Mailing address:
  • Phone: 859-797-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: