Provider Demographics
NPI:1669295770
Name:THOMAS, STEPHANIE DAWN (IBCLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DAWN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3722 RIVA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5539
Mailing Address - Country:US
Mailing Address - Phone:513-370-0115
Mailing Address - Fax:
Practice Address - Street 1:3722 RIVA RIDGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-5539
Practice Address - Country:US
Practice Address - Phone:513-370-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL-36610174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN