Healthcare Provider Details

I. General information

NPI: 1902554108
Provider Name (Legal Business Name): MELODY DATZ HANSEN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 NE 58TH ST
SEATTLE WA
98105-2715
US

IV. Provider business mailing address

348 NE 58TH ST
SEATTLE WA
98105-2715
US

V. Phone/Fax

Practice location:
  • Phone: 206-422-4861
  • Fax:
Mailing address:
  • Phone: 206-422-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-323330
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: