Provider Demographics
NPI:1649505058
Name:FABISCH, ILENE ELLEN (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:ELLEN
Last Name:FABISCH
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 1:664 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4527
Mailing Address - Country:US
Mailing Address - Phone:617-759-7542
Mailing Address - Fax:
Practice Address - Street 1:664 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4527
Practice Address - Country:US
Practice Address - Phone:617-759-7542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-03
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist