Provider Demographics
NPI:1740744325
Name:WONG, KATINA M (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KATINA
Middle Name:M
Last Name:WONG
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:PO BOX 161621
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-1621
Mailing Address - Country:US
Mailing Address - Phone:512-651-9360
Mailing Address - Fax:
Practice Address - Street 1:10619 PLUCHEA CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-5721
Practice Address - Country:US
Practice Address - Phone:703-244-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN