Provider Demographics
NPI:1972370666
Name:CLAUSEN, LISA (IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CLAUSEN
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:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0379
Mailing Address - Country:US
Mailing Address - Phone:651-253-9913
Mailing Address - Fax:
Practice Address - Street 1:506 5TH AVE.
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856-9885
Practice Address - Country:US
Practice Address - Phone:651-253-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL-142482163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant