Provider Demographics
NPI:1285087783
Name:GARDIN, TESSA (IBCLC)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:GARDIN
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 1:25510 POWERLINE PASS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2577
Mailing Address - Country:US
Mailing Address - Phone:832-691-1899
Mailing Address - Fax:
Practice Address - Street 1:25510 POWERLINE PASS DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2577
Practice Address - Country:US
Practice Address - Phone:832-691-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-11255174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN