Provider Demographics
NPI:1508491580
Name:VOGEL, TESSA HELLER (IBCLC)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:HELLER
Last Name:VOGEL
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 1:1541 NW 64TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2343
Mailing Address - Country:US
Mailing Address - Phone:206-399-2195
Mailing Address - Fax:206-399-2195
Practice Address - Street 1:1541 NW 64TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2343
Practice Address - Country:US
Practice Address - Phone:206-399-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-150591OtherIBLCE