Provider Demographics
NPI:1306257340
Name:VANDERBURGH, ALISON (CLC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:VANDERBURGH
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 1:193 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2553
Mailing Address - Country:US
Mailing Address - Phone:207-446-0276
Mailing Address - Fax:
Practice Address - Street 1:193 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2553
Practice Address - Country:US
Practice Address - Phone:207-446-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN