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General NPI Number Information
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NPI Number | 1881530418
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Entity Type | Organization
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Legal Business Name | WILDFLOWER LACTATION AND POSTPARTUM SUPPORT LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 3220 SW 1ST AVE STE 150
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City | PORTLAND
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State | OR
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Zip | 97239-4600
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Country | US
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Telephone | 503-755-8328
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Fax | 503-506-0676
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Provider Business Mailing Address
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Address Line | 3220 SW 1ST AVE STE 150
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City | PORTLAND
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State | OR
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Zip | 97239-4600
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Country | US
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Telephone | 503-755-8328
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Fax | 503-506-0676
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Authorized Official
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Title or Position | SINGLE MEMBER
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Name | ELIZABETH ELLEN WATERS
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Credential | IBCLC
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Telephone | 541-645-3018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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