Provider Demographics
NPI:1275315541
Name:TILLER, WHITNEY LEE (IBCLC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEE
Last Name:TILLER
Suffix:
Gender:M
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 E ALSEA HWY
Mailing Address - Street 2:
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394-9749
Mailing Address - Country:US
Mailing Address - Phone:971-500-4771
Mailing Address - Fax:
Practice Address - Street 1:4334 E ALSEA HWY
Practice Address - Street 2:
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394-9749
Practice Address - Country:US
Practice Address - Phone:971-500-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLC-LC-10235545174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN