Provider Demographics
NPI:1740725456
Name:MALTBY, MEGAN (IBCLC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MALTBY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14534 SW PINOT CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1515
Mailing Address - Country:US
Mailing Address - Phone:925-785-8180
Mailing Address - Fax:
Practice Address - Street 1:14534 SW PINOT CT
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-1515
Practice Address - Country:US
Practice Address - Phone:925-785-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-107913174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN