Provider Demographics
NPI:1619247673
Name:YOUNG, MELISSA CLODFELTER (IBCLC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CLODFELTER
Last Name:YOUNG
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 1:148 OLD SQUAW RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8119
Mailing Address - Country:US
Mailing Address - Phone:704-662-2708
Mailing Address - Fax:
Practice Address - Street 1:148 OLD SQUAW RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8119
Practice Address - Country:US
Practice Address - Phone:704-662-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN