Provider Demographics
NPI:1013451749
Name:SNOHOMISH VALLEY BREASTFEEDING
Entity Type:Organization
Organization Name:SNOHOMISH VALLEY BREASTFEEDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:N
Authorized Official - Last Name:DEMITER
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:253-350-5123
Mailing Address - Street 1:17928 105TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2137
Mailing Address - Country:US
Mailing Address - Phone:253-350-5123
Mailing Address - Fax:
Practice Address - Street 1:24928 OLD PIPELINE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-9861
Practice Address - Country:US
Practice Address - Phone:253-350-5123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty