MEDICARE: JESSICA GASKILL 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)	LC-10189339	OR

General Provider Information

NPI Number	:	1336606862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GASKILL IBCLC

Provider Business Mailing Address
First Line	:	6406 NE 36TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7234
Country	:	US
Telephone Number	:	707-484-3378
Fax Number	:

Provider Business Practice Location Address
First Line	:	6406 NE 36TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7234
Country	:	US
Telephone Number	:	707-484-3378
Fax Number	:

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

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	02/20/2019

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