Healthcare Provider Details

I. General information

NPI: 1750754529
Provider Name (Legal Business Name): CHRISTINA WHITLOW IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 SE 89TH AVE
PORTLAND OR
97216-1713
US

IV. Provider business mailing address

1115 SE 89TH AVE
PORTLAND OR
97216-1713
US

V. Phone/Fax

Practice location:
  • Phone: 503-319-7032
  • Fax:
Mailing address:
  • Phone: 503-319-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number9706
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberLC-LC-10190392
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: