Provider Demographics
NPI:1215669627
Name:MOORE, REBEKAH (CLC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7175 E RAINTREE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-7141
Mailing Address - Country:US
Mailing Address - Phone:615-624-1694
Mailing Address - Fax:
Practice Address - Street 1:19950 7TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7405
Practice Address - Country:US
Practice Address - Phone:360-930-0218
Practice Address - Fax:360-930-8383
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA339188174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA339188OtherTHE ACADEMY OF LACTATION POLICY AND PRACTICE