MEDICARE: HANNAH CHILDS RDN, 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-302722	CO
2	133V00000X	Registered Dietitian	1105751	CO

General Provider Information

NPI Number	:	1245906924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH CHILDS RDN, IBCLC

Provider Business Mailing Address
First Line	:	6170 BARRETT RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926-9506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6170 BARRETT RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926-9506
Country	:	US
Telephone Number	:	719-445-9827
Fax Number	:

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

Provider Enumeration Date	:	08/21/2021
Last Update Date	:	08/21/2021

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