Provider Demographics
NPI:1790137412
Name:SMALLWOOD, ERIN (CLC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 APPLE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-4746
Mailing Address - Country:US
Mailing Address - Phone:317-501-8801
Mailing Address - Fax:
Practice Address - Street 1:5008 APPLE SPRUCE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-4746
Practice Address - Country:US
Practice Address - Phone:317-501-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36991174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN