Provider Demographics
NPI:1750527594
Name:WEST, GWENDOLYN R (IBCLC, RLC)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:R
Last Name:WEST
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:MS
Other - First Name:GWENDOLYN
Other - Middle Name:R
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:509 U ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2338
Mailing Address - Country:US
Mailing Address - Phone:202-378-7536
Mailing Address - Fax:
Practice Address - Street 1:509 U ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2338
Practice Address - Country:US
Practice Address - Phone:202-378-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC191-10809174400000X, 174H00000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-3328131OtherEIN