Provider Demographics
NPI:1174038723
Name:BAILLON, VICKI (MSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:BAILLON
Suffix:
Gender:F
Credentials:MSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BREASTFEEDING HOUSECALLS AND LACTATION CLINIC, LLC
Mailing Address - Street 2:PO BOX 16167
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212
Mailing Address - Country:US
Mailing Address - Phone:210-646-1570
Mailing Address - Fax:281-925-0648
Practice Address - Street 1:15303 HUEBNER RD STE 15
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0983
Practice Address - Country:US
Practice Address - Phone:210-646-1570
Practice Address - Fax:281-925-0648
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-17728163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX654792OtherTEXAS BOARD OF NURSING
TXL-17728OtherIBCLC