Provider Demographics
NPI:1982328092
Name:CLEARY, ANGELA (IBCLC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CLEARY
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 1:645 BLENHEIM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3223
Mailing Address - Country:US
Mailing Address - Phone:614-542-7401
Mailing Address - Fax:
Practice Address - Street 1:645 BLENHEIM RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3223
Practice Address - Country:US
Practice Address - Phone:614-542-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL-307473174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty