Provider Demographics
NPI:1841695020
Name:WHEBBE, EMILY GRACE (IBCLC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:WHEBBE
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 1:1408 W 28TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1935
Mailing Address - Country:US
Mailing Address - Phone:612-860-4060
Mailing Address - Fax:
Practice Address - Street 1:1408 W 28TH ST
Practice Address - Street 2:APT 3
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1935
Practice Address - Country:US
Practice Address - Phone:612-860-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL-56499174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN