Healthcare Provider Details

I. General information

NPI: 1952175366
Provider Name (Legal Business Name): TATYANIA JAMESE GRIFFIN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ROYAL HEIGHTS RD APT 6
BELLEVILLE IL
62226-5491
US

IV. Provider business mailing address

1000 ROYAL HEIGHTS RD APT 6
BELLEVILLE IL
62226-5491
US

V. Phone/Fax

Practice location:
  • Phone: 618-910-1552
  • Fax:
Mailing address:
  • Phone: 618-910-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: