Provider Demographics
NPI:1518265610
Name:MACTAVISH-UNTEN, JOY (IBCLC, ICCE, CD, PCD)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:
Last Name:MACTAVISH-UNTEN
Suffix:
Gender:F
Credentials:IBCLC, ICCE, CD, PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N 145TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6606
Mailing Address - Country:US
Mailing Address - Phone:206-225-8295
Mailing Address - Fax:
Practice Address - Street 1:1902 N 145TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6606
Practice Address - Country:US
Practice Address - Phone:206-225-8295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula