Provider Demographics
NPI:1659817310
Name:JOHNSTON, SUZANNE ELIZABETH (IBCLC)
Entity type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 LAUREL CANYON BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4538
Mailing Address - Country:US
Mailing Address - Phone:310-872-7693
Mailing Address - Fax:
Practice Address - Street 1:5700 LAUREL CANYON BLVD APT 203
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4538
Practice Address - Country:US
Practice Address - Phone:310-872-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-107889174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL-107889OtherIBCLC