Provider Demographics
NPI:1285277376
Name:DAWSON, STEPHANIE RENEA (IBCLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEA
Last Name:DAWSON
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 1:1342 SUNNYDELL FARM LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3001
Mailing Address - Country:US
Mailing Address - Phone:859-797-1068
Mailing Address - Fax:
Practice Address - Street 1:726 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-4738
Practice Address - Country:US
Practice Address - Phone:863-354-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula