Provider Demographics
NPI:1679200125
Name:HUSSER, SAMANTHA BROUSSARD (BA, IBCLC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BROUSSARD
Last Name:HUSSER
Suffix:
Gender:F
Credentials:BA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 DEER FORK XING
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-7013
Mailing Address - Country:US
Mailing Address - Phone:985-789-2542
Mailing Address - Fax:
Practice Address - Street 1:717 DEER FORK XING
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-7013
Practice Address - Country:US
Practice Address - Phone:985-789-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-306085174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN