Provider Demographics
NPI:1295320117
Name:RAVENSCRAFT, BROOKE (IBCLC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:RAVENSCRAFT
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 1:14586 PRIVATE ROAD 3643
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539-3896
Mailing Address - Country:US
Mailing Address - Phone:254-466-9155
Mailing Address - Fax:
Practice Address - Street 1:14586 PRIVATE ROAD 3643
Practice Address - Street 2:
Practice Address - City:KEMPNER
Practice Address - State:TX
Practice Address - Zip Code:76539-3896
Practice Address - Country:US
Practice Address - Phone:254-466-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-164496174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN