Provider Demographics
NPI:1659817310
Name:JOHNSTON, SUZANNE (IBCLC)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:
Last Name:JOHNSTON
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 1:13920 MOORPARK ST
Mailing Address - Street 2:#206
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-5700
Mailing Address - Country:US
Mailing Address - Phone:323-786-2652
Mailing Address - Fax:818-990-1588
Practice Address - Street 1:13920 MOORPARK ST
Practice Address - Street 2:#206
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-5700
Practice Address - Country:US
Practice Address - Phone:323-786-2652
Practice Address - Fax:818-990-1588
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-107889174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL-107889OtherIBCLC