Provider Demographics
NPI:1043196876
Name:FORT WAYNE DOULAS, LLC
Entity type:Organization
Organization Name:FORT WAYNE DOULAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SICKELS
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:260-782-4666
Mailing Address - Street 1:407 AIRPORT NORTH OFFICE PARK STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6704
Mailing Address - Country:US
Mailing Address - Phone:260-782-4666
Mailing Address - Fax:800-776-4346
Practice Address - Street 1:407 AIRPORT NORTH OFFICE PARK STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6704
Practice Address - Country:US
Practice Address - Phone:260-782-4666
Practice Address - Fax:800-776-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty