Provider Demographics
NPI:1649828310
Name:DEITCH, COURTNEY LEE (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LEE
Last Name:DEITCH
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 1:1727 IMPERIAL BLVD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5393
Mailing Address - Country:US
Mailing Address - Phone:337-564-7953
Mailing Address - Fax:337-478-5879
Practice Address - Street 1:1727 IMPERIAL BLVD BLDG 3
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5393
Practice Address - Country:US
Practice Address - Phone:337-564-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-145567174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN