Provider Demographics
NPI:1689926461
Name:HOLSON, SUZANNE LINDSAY (IBCLC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LINDSAY
Last Name:HOLSON
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 1:4317 JONATHAN COURT
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1142
Mailing Address - Country:US
Mailing Address - Phone:703-785-4018
Mailing Address - Fax:703-680-9702
Practice Address - Street 1:4317 JONATHAN COURT
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1142
Practice Address - Country:US
Practice Address - Phone:703-785-4018
Practice Address - Fax:703-680-9702
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAIBCLC#10522208174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN