Provider Demographics
NPI:1528765450
Name:PEARSON, BRYN (IBCLC)
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:
Last Name:PEARSON
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 1:82 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2000
Mailing Address - Country:US
Mailing Address - Phone:812-325-0334
Mailing Address - Fax:
Practice Address - Street 1:82 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-2000
Practice Address - Country:US
Practice Address - Phone:812-325-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-307069174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN