Provider Demographics
NPI:1538584719
Name:THE MOTHER BABY CONNECTION
Entity type:Organization
Organization Name:THE MOTHER BABY CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK-GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:703-501-8983
Mailing Address - Street 1:HC 64 BOX 100-22
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:26865-9506
Mailing Address - Country:US
Mailing Address - Phone:703-501-8983
Mailing Address - Fax:
Practice Address - Street 1:HC 64 BOX 100-22
Practice Address - Street 2:
Practice Address - City:YELLOW SPRING
Practice Address - State:WV
Practice Address - Zip Code:26865-9506
Practice Address - Country:US
Practice Address - Phone:703-501-8983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001092828163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty