Healthcare Provider Details

I. General information

NPI: 1841917861
Provider Name (Legal Business Name): HALEY IBCLC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 HINESBURG RD
SOUTH BURLINGTON VT
05403-6534
US

IV. Provider business mailing address

241 HINESBURG RD
SOUTH BURLINGTON VT
05403-6534
US

V. Phone/Fax

Practice location:
  • Phone: 802-734-3847
  • Fax:
Mailing address:
  • Phone: 802-734-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: HALEY WORGAN
Title or Position: OWNER
Credential: BSN, RN, IBCLC
Phone: 802-734-3847