Provider Demographics
NPI:1710344395
Name:BIRKEY, AMANDA (IBCLC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BIRKEY
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 1:413 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61747-7502
Mailing Address - Country:US
Mailing Address - Phone:309-449-6275
Mailing Address - Fax:
Practice Address - Street 1:413 MONROE ST
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:IL
Practice Address - Zip Code:61747-7502
Practice Address - Country:US
Practice Address - Phone:309-449-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN