Healthcare Provider Details

I. General information

NPI: 1720646680
Provider Name (Legal Business Name): MICHELLE MADRIGAL LM, CPM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 NATOOKA CT SE
OLYMPIA WA
98513-7715
US

IV. Provider business mailing address

8833 NATOOKA CT SE
OLYMPIA WA
98513-7715
US

V. Phone/Fax

Practice location:
  • Phone: 360-490-3194
  • Fax:
Mailing address:
  • Phone: 360-490-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-316325
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60901993
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: