Provider Demographics
NPI:1164709549
Name:FOREMAN, GILLIAN G (MA, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:G
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:MA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 STOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2025
Mailing Address - Country:US
Mailing Address - Phone:214-208-5535
Mailing Address - Fax:
Practice Address - Street 1:5011 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2040
Practice Address - Country:US
Practice Address - Phone:214-208-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 174H00000X, 374J00000X
L-310591174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula