Provider Demographics
NPI:1497087282
Name:BERGSMITH, JUDY ANN (RN-IBCLC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:BERGSMITH
Suffix:
Gender:F
Credentials:RN-IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 N 2ND ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3276
Mailing Address - Country:US
Mailing Address - Phone:815-517-1783
Mailing Address - Fax:815-517-1783
Practice Address - Street 1:147 N 2ND ST
Practice Address - Street 2:SUITE 11
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3276
Practice Address - Country:US
Practice Address - Phone:815-517-1783
Practice Address - Fax:815-517-1783
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.231280163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant