Provider Demographics
NPI:1316478951
Name:LECLERCQ, ANNE (MIDWIFE, IBCLC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:LECLERCQ
Suffix:
Gender:F
Credentials:MIDWIFE, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10905 MARBLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1517
Mailing Address - Country:US
Mailing Address - Phone:512-750-6785
Mailing Address - Fax:
Practice Address - Street 1:10905 MARBLE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1517
Practice Address - Country:US
Practice Address - Phone:512-750-6785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99281176B00000X
TXL-311925174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No176B00000XOther Service ProvidersMidwife