Provider Demographics
NPI:1912271156
Name:NEALE, LINDA (IBCLC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:NEALE
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:PO BOX 17842
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-0842
Mailing Address - Country:US
Mailing Address - Phone:303-530-0708
Mailing Address - Fax:303-431-2599
Practice Address - Street 1:2050 PARK LAKE DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5121
Practice Address - Country:US
Practice Address - Phone:303-530-0708
Practice Address - Fax:303-431-2599
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN