Provider Demographics
NPI:1992155089
Name:KOZNEK, ADRIENNE ROSE (IBCLC)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:ROSE
Last Name:KOZNEK
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:ROSE
Other - Last Name:HERSHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11312 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8404
Mailing Address - Country:US
Mailing Address - Phone:503-830-5257
Mailing Address - Fax:503-893-3086
Practice Address - Street 1:5440 SW WESTGATE DR STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221
Practice Address - Country:US
Practice Address - Phone:503-830-5257
Practice Address - Fax:503-893-3086
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-99082174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN