Individual
BETHANY FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD, IBCLC
Contact information
Practice address
1022 E COUNTY ROAD 2770, NIOTA, IL 62358-2018
(319) 316-2004
Mailing address
1022 E COUNTY ROAD 2770, NIOTA, IL 62358-2018
(319) 316-2004
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
164.007516
IL
174N00000X
Lactation Consultant (Non-RN)
Primary
L-311161
—
Other
Enumeration date
10/04/2018
Last updated
05/05/2026
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