Provider Demographics
NPI:1902531072
Name:CORP-MYER, JACQUELINE KAY (IBCLC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KAY
Last Name:CORP-MYER
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 1:17049 431ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9650
Mailing Address - Country:US
Mailing Address - Phone:315-396-2857
Mailing Address - Fax:
Practice Address - Street 1:17049 431ST AVE SE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-9650
Practice Address - Country:US
Practice Address - Phone:315-396-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-307756174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN