Provider Demographics
NPI:1427432210
Name:WILLIAMS, ELIZABETH RAE SUSANNE (CLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RAE SUSANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-2617
Mailing Address - Country:US
Mailing Address - Phone:406-202-3685
Mailing Address - Fax:
Practice Address - Street 1:608 3RD ST W
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2617
Practice Address - Country:US
Practice Address - Phone:406-202-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227141174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN