Provider Demographics
NPI:1982063871
Name:GORDON-WILCOX, DAWN (IBCLC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GORDON-WILCOX
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 1:16 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4340
Mailing Address - Country:US
Mailing Address - Phone:406-533-5437
Mailing Address - Fax:
Practice Address - Street 1:25 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2801
Practice Address - Country:US
Practice Address - Phone:406-497-5060
Practice Address - Fax:406-497-5099
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN