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NPI Code Detail

MEDICARE: COURTNEY JADE HAMILTON CLEC, IBCLC

MEDICARE:   COURTNEY JADE HAMILTON  CLEC, 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
1174N00000XLactation Consultant (Non-RN)TX

General Provider Information

NPI Number : 1376178855
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY JADE HAMILTON CLEC, IBCLC
Provider Business Mailing Address
First Line : 149 TOWNLAKE DR
Second Line :
City : PROSPER
State : TX
Zip : 75078-8983
Country : US
Telephone Number : 214-546-5256
Fax Number :
Provider Business Practice Location Address
First Line : 107 MURRAY ST
Second Line :
City : DALLAS
State : TX
Zip : 75226-1645
Country : US
Telephone Number : 469-608-0071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2020
Last Update Date : 03/05/2020

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Directions to “ COURTNEY JADE HAMILTON CLEC, IBCLC” Practice Location

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