Basic Information
| Provider Information | |||||||||
| NPI: | 1174038723 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILLON | ||||||||
| FirstName: | VICKI | ||||||||
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| Credential: | MSN, RN, IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | BREASTFEEDING HOUSECALLS AND LACTATION CLINIC, LLC | ||||||||
| Address2: | PO BOX 16167 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106461570 | ||||||||
| FaxNumber: | 2819250648 | ||||||||
| Practice Location | |||||||||
| Address1: | 15303 HUEBNER RD STE 15 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782480983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106461570 | ||||||||
| FaxNumber: | 2819250648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2017 | ||||||||
| LastUpdateDate: | 12/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | L-17728 | TX | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
ID Information
| ID | Type | State | Issuer | Description | 654792 | 01 | TX | TEXAS BOARD OF NURSING | OTHER | L-17728 | 01 | TX | IBCLC | OTHER |