Provider Demographics
NPI:1588109458
Name:STROUD, DENISE (IBCLC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:STROUD
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 1:159 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-7523
Mailing Address - Country:US
Mailing Address - Phone:478-952-9151
Mailing Address - Fax:
Practice Address - Street 1:159 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-7523
Practice Address - Country:US
Practice Address - Phone:478-952-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN