Provider Demographics
NPI:1457000317
Name:GIBSON, SARAH (IBCLC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GIBSON
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 1:7200 CRESHEIM RD APT B5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2420
Mailing Address - Country:US
Mailing Address - Phone:215-730-7125
Mailing Address - Fax:
Practice Address - Street 1:7200 CRESHEIM RD APT B5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2420
Practice Address - Country:US
Practice Address - Phone:215-730-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-305566174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN