Provider Demographics
NPI:1518424563
Name:HAVERON, ULRIKKE FRANCES (IBCLC)
Entity type:Individual
Prefix:MS
First Name:ULRIKKE
Middle Name:FRANCES
Last Name:HAVERON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:ULRIKKA, ULI
Other - Middle Name:FRANCES
Other - Last Name:HAVERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7043 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5611
Mailing Address - Country:US
Mailing Address - Phone:503-449-7864
Mailing Address - Fax:
Practice Address - Street 1:7043 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5611
Practice Address - Country:US
Practice Address - Phone:503-449-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLC-LC-10197349174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty