Provider Demographics
NPI:1164276424
Name:SPENCER-STREETER, RONDA LYNN (IBCLC)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:LYNN
Last Name:SPENCER-STREETER
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 1:173 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1021
Mailing Address - Country:US
Mailing Address - Phone:989-423-4083
Mailing Address - Fax:
Practice Address - Street 1:173 N MONROE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1021
Practice Address - Country:US
Practice Address - Phone:989-423-4083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-108388174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN