Provider Demographics
NPI:1447525449
Name:SJOBLOM, ELIZABETH SUSAN (RN, BSN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:SJOBLOM
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 WEST BLOOMINGDALE
Mailing Address - Street 2:UNIT 2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647
Mailing Address - Country:US
Mailing Address - Phone:847-452-0041
Mailing Address - Fax:
Practice Address - Street 1:2448 W BLOOMINGDALE AVE
Practice Address - Street 2:UNIT 2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6285
Practice Address - Country:US
Practice Address - Phone:847-452-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041349621163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant