Provider Demographics
NPI:1568052157
Name:THOMAS, ALLISON KAY (IBCLC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:KAY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:KAY
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-9754
Mailing Address - Country:US
Mailing Address - Phone:217-621-7091
Mailing Address - Fax:
Practice Address - Street 1:708 W STATE ST
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9754
Practice Address - Country:US
Practice Address - Phone:217-621-7091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.431305163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant