Provider Demographics
NPI:1104297613
Name:LAVON, MELINDA (PHD CPM IBCLC)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:LAVON
Suffix:
Gender:F
Credentials:PHD CPM IBCLC
Other - Prefix:DR
Other - First Name:MELINDA
Other - Middle Name:LAVON
Other - Last Name:TOUMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD CPM IBCLC
Mailing Address - Street 1:1440 WAKARUSA DR
Mailing Address - Street 2:STE 400
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-979-2477
Mailing Address - Fax:913-273-3120
Practice Address - Street 1:1440 WAKARUSA DR
Practice Address - Street 2:STE 400
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-979-2477
Practice Address - Fax:913-273-3120
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZB0500X, 251K00000X, 174H00000X, 174N00000X, 176B00000X
19110030176B00000X
L-87168174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemist
No251K00000XAgenciesPublic Health or Welfare
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN