Provider Demographics
NPI:1699308668
Name:LOUIE, STACY-ANN LATOYA (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:STACY-ANN
Middle Name:LATOYA
Last Name:LOUIE
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 1:1730 MONTRACHET DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3190
Mailing Address - Country:US
Mailing Address - Phone:678-750-3121
Mailing Address - Fax:
Practice Address - Street 1:3160 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3461
Practice Address - Country:US
Practice Address - Phone:678-750-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL142321174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN