Provider Demographics
NPI:1609406057
Name:TREADWELL, ASHLEY (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 SE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4920
Mailing Address - Country:US
Mailing Address - Phone:917-744-3657
Mailing Address - Fax:
Practice Address - Street 1:4529 SE 52ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-4920
Practice Address - Country:US
Practice Address - Phone:917-744-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLC-LC-10191891174N00000X
CAL-50277174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104255991OtherORGANIZATIONAL NPI