MEDICARE: LACTATION AND PEDIATRIC ORAL DYSFUNCTION CONSULTANTS, LLC

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	235Z00000X	Speech-Language Pathologist
2	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1679355945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACTATION AND PEDIATRIC ORAL DYSFUNCTION CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	9724 KINGSTON PIKE STE 1003
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6906
Country	:	US
Telephone Number	:	865-217-6330
Fax Number	:

Provider Business Practice Location Address
First Line	:	9724 KINGSTON PIKE STE 1003
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6906
Country	:	US
Telephone Number	:	865-217-6330
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CATHERINE QUINTERO
Credential	:
Telephone Number	:	865-217-6330

Provider Enumeration Date	:	10/19/2023
Last Update Date	:	03/18/2026

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