Provider Demographics
NPI:1669724993
Name:VALENTE, LAURA MICHELLE (MED, IBCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:VALENTE
Suffix:
Gender:F
Credentials:MED, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 MELVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4602
Mailing Address - Country:US
Mailing Address - Phone:773-663-6622
Mailing Address - Fax:
Practice Address - Street 1:3100 SUTTON BLVD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3910
Practice Address - Country:US
Practice Address - Phone:773-663-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL-83469174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN