Provider Demographics
NPI:1972965762
Name:WORTHINGTON, NATALIE (IBCLC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:DUMONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:2655 JENNA CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4005
Mailing Address - Country:US
Mailing Address - Phone:630-881-2277
Mailing Address - Fax:
Practice Address - Street 1:2655 JENNA CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-4005
Practice Address - Country:US
Practice Address - Phone:630-881-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-47064174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN