Healthcare Provider Details

I. General information

NPI: 1104297613
Provider Name (Legal Business Name): MELINDA LAVON PHD CPM IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINDA LAVON TOUMI PHD CPM IBCLC

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 05/28/2022
Certification Date: 05/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 WAKARUSA DR STE 400
LAWRENCE KS
66049
US

IV. Provider business mailing address

1440 WAKARUSA DR STE 400
LAWRENCE KS
66049
US

V. Phone/Fax

Practice location:
  • Phone: 785-979-2477
  • Fax: 913-273-3120
Mailing address:
  • Phone: 785-979-2477
  • Fax: 913-273-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number19110030
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code246ZB0500X
TaxonomyBiochemist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-87168
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: