Provider Demographics
NPI:1588247480
Name:SLAUGHTER, SAMANTHA (IBCLC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4320 NARRAGANSET WAY
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-3037
Mailing Address - Country:US
Mailing Address - Phone:916-600-2698
Mailing Address - Fax:
Practice Address - Street 1:2143 HURLEY WAY STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3299
Practice Address - Country:US
Practice Address - Phone:916-326-5835
Practice Address - Fax:916-444-5494
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-23072174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-23072OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS