Provider Demographics
NPI:1053936575
Name:MASON, LAURA BETH (IBCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:MASON
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 1:2424 LUDDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2563
Mailing Address - Country:US
Mailing Address - Phone:419-514-5053
Mailing Address - Fax:
Practice Address - Street 1:2424 LUDDINGTON DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2563
Practice Address - Country:US
Practice Address - Phone:419-514-5053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-140370174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN