Individual
AUTUMN ROSE WAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
260 E 200 N, PROVO, UT 84606-3180
(801) 786-9613
Mailing address
260 E 200 N, PROVO, UT 84606-3180
(801) 786-9613
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
Other
Enumeration date
12/12/2025
Last updated
12/12/2025
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