Provider Demographics
NPI:1083992853
Name:SIEGRIST, AMY MARIE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2217
Mailing Address - Country:US
Mailing Address - Phone:484-919-1027
Mailing Address - Fax:
Practice Address - Street 1:992 OLD EAGLE SCHOOL RD
Practice Address - Street 2:SUITE 902
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1803
Practice Address - Country:US
Practice Address - Phone:484-919-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA108-26498174N00000X, 174400000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003140774OtherINDEPENDENCE BLUE CROSS
PA9929902OtherAETNA