Provider Demographics
NPI:1780396085
Name:ROSS, STEPHANIE TANYA (IBCLC, CLC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:TANYA
Last Name:ROSS
Suffix:
Gender:F
Credentials:IBCLC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-7926
Mailing Address - Country:US
Mailing Address - Phone:931-808-3368
Mailing Address - Fax:
Practice Address - Street 1:233 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-7926
Practice Address - Country:US
Practice Address - Phone:931-808-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-306804174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN