Provider Demographics
NPI:1396142170
Name:GOSS, ALYSSA (IBCLC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GOSS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-7804
Mailing Address - Country:US
Mailing Address - Phone:512-415-8627
Mailing Address - Fax:
Practice Address - Street 1:2918 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-7804
Practice Address - Country:US
Practice Address - Phone:512-415-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-23
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-56531174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN