Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1265994305 |
---|---|
Provider Name | Jodi Gordon Congdon |
First Address | Foxboro, MA 02035-2326 |
Second Address | Foxboro, MA 02035-2326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 05/04/2019 |