Provider Demographics
NPI:1730646167
Name:LORENZEN, STEPHANIE ANNE (IBCLC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:LORENZEN
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 1:26305 N 1325TH ST
Mailing Address - Street 2:
Mailing Address - City:CHRISMAN
Mailing Address - State:IL
Mailing Address - Zip Code:61924-7075
Mailing Address - Country:US
Mailing Address - Phone:805-558-0332
Mailing Address - Fax:
Practice Address - Street 1:26305 N 1325TH ST
Practice Address - Street 2:
Practice Address - City:CHRISMAN
Practice Address - State:IL
Practice Address - Zip Code:61924-7075
Practice Address - Country:US
Practice Address - Phone:805-558-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-151809174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN