Healthcare Provider Details

I. General information

NPI: 1538669056
Provider Name (Legal Business Name): EBB & FLOW LACTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 10/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 COLUMBUS RD STE 105
ATHENS OH
45701-1393
US

IV. Provider business mailing address

PO BOX 393
ATHENS OH
45701-0393
US

V. Phone/Fax

Practice location:
  • Phone: 740-818-8871
  • Fax: 844-442-5114
Mailing address:
  • Phone: 740-818-8871
  • Fax: 844-442-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE ALAYNE GLADNEY
Title or Position: LACTATION CONSULTANT/OWNER
Credential: BS, LPN, IBCLC
Phone: 740-818-8871