Provider Demographics
NPI:1851649164
Name:LUDWIG, HEATHER LAURIE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LAURIE
Last Name:LUDWIG
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 1:201 W KENYON RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7892
Mailing Address - Country:US
Mailing Address - Phone:217-531-4289
Mailing Address - Fax:217-531-4297
Practice Address - Street 1:201 W KENYON RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7892
Practice Address - Country:US
Practice Address - Phone:217-531-4289
Practice Address - Fax:217-531-4297
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11041076174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN