Healthcare Provider Details

I. General information

NPI: 1598674079
Provider Name (Legal Business Name): EMILY ZOID IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY WISE

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 N SHERIDAN RD
PEORIA IL
61604-3457
US

IV. Provider business mailing address

1715 KING DR APT D
NORMAL IL
61761-5906
US

V. Phone/Fax

Practice location:
  • Phone: 309-679-6033
  • Fax:
Mailing address:
  • Phone: 815-343-9479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-323211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: