Provider Demographics
NPI:1992522858
Name:SICKELS, AMY JO (IBCLC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:SICKELS
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 1:3317 HOAGLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-1921
Mailing Address - Country:US
Mailing Address - Phone:260-437-7653
Mailing Address - Fax:
Practice Address - Street 1:9835 AUBURN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2347
Practice Address - Country:US
Practice Address - Phone:260-222-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INL-313206174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN