Healthcare Provider Details

I. General information

NPI: 1609123652
Provider Name (Legal Business Name): HEATHER G BINGHAM IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 MARY ST
ARLINGTON MA
02474-8847
US

IV. Provider business mailing address

143 MARY ST
ARLINGTON MA
02474-8847
US

V. Phone/Fax

Practice location:
  • Phone: 781-648-2988
  • Fax:
Mailing address:
  • Phone: 781-648-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number142899
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: