Provider Demographics
NPI:1326593971
Name:BLISS LACTATION, LLC
Entity Type:Organization
Organization Name:BLISS LACTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESORBO
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:503-593-9432
Mailing Address - Street 1:13230 NE SACRAMENTO DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-3035
Mailing Address - Country:US
Mailing Address - Phone:503-593-9432
Mailing Address - Fax:503-777-0445
Practice Address - Street 1:4004 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7662
Practice Address - Country:US
Practice Address - Phone:503-777-0444
Practice Address - Fax:503-777-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-99965261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL-99965OtherIBCLC ID NUMBER