Provider Demographics
NPI:1902252778
Name:DENISON, SUSAN L (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:DENISON
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 1:3228 BUCHANAN AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49548-2170
Mailing Address - Country:US
Mailing Address - Phone:616-802-2434
Mailing Address - Fax:
Practice Address - Street 1:3228 BUCHANAN AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49548-2170
Practice Address - Country:US
Practice Address - Phone:616-802-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL-31924174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN