Healthcare Provider Details

I. General information

NPI: 1164709549
Provider Name (Legal Business Name): GILLIAN G FOREMAN MA, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2011
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 KENWOOD RD
CINCINNATI OH
45227-2040
US

IV. Provider business mailing address

1719 STOCKTON DR
LOVELAND OH
45140-2025
US

V. Phone/Fax

Practice location:
  • Phone: 214-208-5535
  • Fax:
Mailing address:
  • Phone: 214-208-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-310591
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: