Provider Demographics
NPI:1821869322
Name:MAIZE, EMILY WELLINGTON (IBCLC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WELLINGTON
Last Name:MAIZE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:WELLINGTON
Other - Last Name:JACOBBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2235 NW HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1572
Mailing Address - Country:US
Mailing Address - Phone:541-499-2190
Mailing Address - Fax:541-499-2190
Practice Address - Street 1:2314 NW KINGS BLVD STE A
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3925
Practice Address - Country:US
Practice Address - Phone:541-286-4030
Practice Address - Fax:541-286-4158
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN