Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 193200000X | IL |
NPI | 1235694126 |
---|---|
Provider Name | Tahlor E Mattison |
First Address | Lynwood, IL 60411-4623 |
Second Address | Orland Park, IL 60462-4766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 05/02/2019 |