Provider Demographics
NPI:1225614241
Name:MACKIEWICZ, CASSANDRA NATASHA (IBCLC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:NATASHA
Last Name:MACKIEWICZ
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 1:10190 W CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5318
Mailing Address - Country:US
Mailing Address - Phone:951-552-0010
Mailing Address - Fax:
Practice Address - Street 1:10190 W CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5318
Practice Address - Country:US
Practice Address - Phone:951-552-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDL-106475174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN