Provider Demographics
NPI:1952079865
Name:PEARSON, RENEE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:PEARSON
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 1:24346 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1064
Mailing Address - Country:US
Mailing Address - Phone:313-736-1863
Mailing Address - Fax:
Practice Address - Street 1:24346 GROVE AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1064
Practice Address - Country:US
Practice Address - Phone:313-736-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN