Provider Demographics
NPI:1902437361
Name:GULF COAST LACTATION
Entity Type:Organization
Organization Name:GULF COAST LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:251-455-8928
Mailing Address - Street 1:368 COMMERCIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1910
Mailing Address - Country:US
Mailing Address - Phone:251-455-8928
Mailing Address - Fax:
Practice Address - Street 1:368 COMMERCIAL PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1910
Practice Address - Country:US
Practice Address - Phone:251-455-8928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty