Provider Demographics
NPI:1285330969
Name:CHARNO, JILL (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:CHARNO
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:GITTINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7722 SE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6012
Mailing Address - Country:US
Mailing Address - Phone:503-960-1051
Mailing Address - Fax:
Practice Address - Street 1:7722 SE 15TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6012
Practice Address - Country:US
Practice Address - Phone:503-960-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-308230174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN