Healthcare Provider Details

I. General information

NPI: 1992512107
Provider Name (Legal Business Name): TESS BELDEN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 COMMERCE PARK PL STE E
INDIANAPOLIS IN
46268-3128
US

IV. Provider business mailing address

8770 COMMERCE PARK PL STE E
INDIANAPOLIS IN
46268-3128
US

V. Phone/Fax

Practice location:
  • Phone: 317-313-0462
  • Fax:
Mailing address:
  • Phone: 317-495-8967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-317365
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: