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NPI Code Detail

MEDICARE: AMY JO SICKELS IBCLC

MEDICARE: AMY JO SICKELS 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)L-313206IN

General Provider Information

NPI Number : 1992522858
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY JO SICKELS IBCLC
Provider Business Mailing Address
First Line : 3317 HOAGLAND AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1921
Country : US
Telephone Number : 260-437-7653
Fax Number :
Provider Business Practice Location Address
First Line : 9835 AUBURN RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-2347
Country : US
Telephone Number : 260-222-7406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2024
Last Update Date : 09/23/2024

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