Provider Demographics
NPI:1205653029
Name:CHANG, ELIZABETH (BSC, IBCLC, CLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:BSC, IBCLC, CLC
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 390962
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94039-0962
Mailing Address - Country:US
Mailing Address - Phone:908-938-5320
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 390962
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94039-0962
Practice Address - Country:US
Practice Address - Phone:908-938-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty