MEDICARE: JERI BALL LPN IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-46966	OH

General Provider Information

NPI Number	:	1215350244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERI BALL LPN IBCLC

Provider Business Mailing Address
First Line	:	6325 LIEB DR
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44216-9131
Country	:	US
Telephone Number	:	330-603-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	6325 LIEB DR
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44216-9131
Country	:	US
Telephone Number	:	330-603-0793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	03/07/2014

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