Provider Demographics
NPI:1780226126
Name:JOHNSON, SHERILYN H (LC IBCLC L-128076)
Entity Type:Individual
Prefix:
First Name:SHERILYN
Middle Name:H
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LC IBCLC L-128076
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1354
Mailing Address - Country:US
Mailing Address - Phone:509-480-0544
Mailing Address - Fax:
Practice Address - Street 1:1312 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1354
Practice Address - Country:US
Practice Address - Phone:509-480-0544
Practice Address - Fax:509-823-4333
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL-128076163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAL-128076OtherLACTATION CONSULTANT