Provider Demographics
NPI:1932929429
Name:LILLEY, STEPHANIE (IBCLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LILLEY
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 1:2350 N LAKE OF THE WOODS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-6936
Mailing Address - Country:US
Mailing Address - Phone:573-310-9318
Mailing Address - Fax:
Practice Address - Street 1:2350 N LAKE OF THE WOODS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-6936
Practice Address - Country:US
Practice Address - Phone:573-310-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL-68015163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant