Healthcare Provider Details

I. General information

NPI: 1982063871
Provider Name (Legal Business Name): DAWN GORDON-WILCOX IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W FRONT ST
BUTTE MT
59701-2801
US

IV. Provider business mailing address

16 REDWOOD DR
BUTTE MT
59701-4340
US

V. Phone/Fax

Practice location:
  • Phone: 406-497-5060
  • Fax: 406-497-5099
Mailing address:
  • Phone: 406-533-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: