Provider Demographics
NPI:1275072563
Name:HOROWITZ, SONYA M (IBCLC, CPM)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:M
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:IBCLC, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3822 SW ALICE STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-453-5292
Mailing Address - Fax:
Practice Address - Street 1:3822 SW ALICE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5343
Practice Address - Country:US
Practice Address - Phone:503-453-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-13030174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN