Healthcare Provider Details

I. General information

NPI: 1962747329
Provider Name (Legal Business Name): KAREN DICKERT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 N ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004-1582
US

IV. Provider business mailing address

326 STONEBRIDGE WAY
MUNDELEIN IL
60060-3391
US

V. Phone/Fax

Practice location:
  • Phone: 837-398-0400
  • Fax:
Mailing address:
  • Phone: 847-722-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041-174965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: