MEDICARE: JESSICA CULLISON MS, RDN, LDN, 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-305884	PA

General Provider Information

NPI Number	:	1225971278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CULLISON MS, RDN, LDN, IBCLC

Provider Business Mailing Address
First Line	:	601 TIMBER DR
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-2359
Country	:	US
Telephone Number	:	484-883-6516
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 TIMBER DR
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-2359
Country	:	US
Telephone Number	:	484-883-6516
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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