Provider Demographics
NPI:1780933747
Name:GALLE, PAMELA JEAN (IBCLC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:GALLE
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 1:1316 EAST TENTH STREET
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1510
Mailing Address - Country:US
Mailing Address - Phone:218-340-6203
Mailing Address - Fax:
Practice Address - Street 1:1316 EAST TENTH STREET
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1510
Practice Address - Country:US
Practice Address - Phone:218-340-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10016426174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN