Provider Demographics
NPI:1265842546
Name:IWASZKOWIEC, JOHANNA ELISABETH (IBCLC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELISABETH
Last Name:IWASZKOWIEC
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 1:3104 WATERWHEEL PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2433
Mailing Address - Country:US
Mailing Address - Phone:636-486-6016
Mailing Address - Fax:
Practice Address - Street 1:3104 WATERWHEEL PL
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2433
Practice Address - Country:US
Practice Address - Phone:636-306-3410
Practice Address - Fax:636-206-8193
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula