Healthcare Provider Details

I. General information

NPI: 1770880155
Provider Name (Legal Business Name): HEALTHY BEGINNINGS LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N 115TH ST SUITE 205A
SEATTLE WA
98133-8421
US

IV. Provider business mailing address

19410 HIGHWAY 99 SUITE A-212
LYNNWOOD WA
98036-5102
US

V. Phone/Fax

Practice location:
  • Phone: 559-424-6455
  • Fax:
Mailing address:
  • Phone: 559-425-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN 00085501
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN 00123681
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN 00155625
License Number StateWA

VIII. Authorized Official

Name: KELSEY SUSAN STEVENS
Title or Position: CO-OWNER
Credential: RN, IBCLC
Phone: 559-425-6455