MEDICARE: ELIZABETH WEGLICKI HOMANS IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-310884	OH

General Provider Information

NPI Number	:	1558138172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WEGLICKI HOMANS IBCLC

Provider Business Mailing Address
First Line	:	821 SUN RIDGE LN
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-4257
Country	:	US
Telephone Number	:	720-495-2243
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 SUN RIDGE LN
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-4257
Country	:	US
Telephone Number	:	720-495-2243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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