Provider Demographics
NPI:1558790204
Name:LORICK, ELIZABETH GLENN (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GLENN
Last Name:LORICK
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 MEMORIAL PKWY SW STE H
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2209
Mailing Address - Country:US
Mailing Address - Phone:256-489-2590
Mailing Address - Fax:256-489-2584
Practice Address - Street 1:7540 MEMORIAL PKWY SW STE H
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2209
Practice Address - Country:US
Practice Address - Phone:256-489-2590
Practice Address - Fax:256-489-2584
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19613394174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN