Provider Demographics
NPI:1578199881
Name:LICZBINSKI, EMILY FULLMER (IBCLC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:FULLMER
Last Name:LICZBINSKI
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 1:2753 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4155
Mailing Address - Country:US
Mailing Address - Phone:214-516-5355
Mailing Address - Fax:
Practice Address - Street 1:2753 SCENIC DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4155
Practice Address - Country:US
Practice Address - Phone:214-516-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN