Provider Demographics
NPI:1710578448
Name:LIQUID GOLD LACTATION LLC
Entity type:Organization
Organization Name:LIQUID GOLD LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:SUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MED, IBCLC
Authorized Official - Phone:832-445-9757
Mailing Address - Street 1:19100 W LAKE HOUSTON PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5139
Mailing Address - Country:US
Mailing Address - Phone:281-626-8241
Mailing Address - Fax:
Practice Address - Street 1:19100 W LAKE HOUSTON PKWY STE 104
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5139
Practice Address - Country:US
Practice Address - Phone:281-626-8241
Practice Address - Fax:281-336-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty