Elizabeth Ellen Waters, IBCLC, RLC, CPPD

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

LC-10196698 Issued in OR

Practice address

3323 SW Naito Pkwy
Portland, OR 97239-4672

Phone

(503) 755-8328

Fax

(503) 506-0676

NPI assigned

Jan 29, 2019

Last updated

Jun 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Elizabeth Ellen Waters Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wildflower Lactation

  • Lactation Consultant (Non-RN)
  • Portland, OR
  • NPI 1417793746

  Lactation Consultant, Non-RN

  NPD Authorized official
• Wildflower Lactation and Postpartum Support LLC

  • Lactation Consultant (Registered Nurse)
  • Portland, OR
  • NPI 1881530418

  Lactation Consultant, Non-RN

  NPD Authorized official
• Columbia Gorge Postpartum Support

  • Lactation Consultant (Non-RN)
  • Hood River, OR
  • NPI 1881284123

  Lactation Consultant, Non-RN

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1932663309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "462 SW VALERIA VIEW DR APT 303",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972257085",
            "telephone_number": "503-755-8328",
            "fax_number": "503-506-0676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3323 SW NAITO PKWY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394672",
            "telephone_number": "503-755-8328",
            "fax_number": "503-506-0676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "ELIZABETH",
        "middle_name": "ELLEN",
        "credential": "IBCLC, RLC, CPPD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "OR",
            "license": "LC-10196698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500820297",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON HEALTH LICENSING-LACTATION CONSULTANT PROGRAM",
            "identifier": "LC-LC-10196698",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS",
            "identifier": "L-152153",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "WATERS",
            "middle_name": "ELLEN",
            "credential": "IBCLC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anna Waters, ED.D.
• Carlesha Waters
• Chase Garrett Waters, DAOM, MTCM, LAC,
• Daniel Waters
• Elisha M Waters, BA, CADCI
• Georgina Claire Waters, MBBS
• Igwe Waters
• Ismond Waters
• Jennifer Waters
• Joan Lee Waters, GENERAL STUDIES AS

• Lactation Consultant (Non-RN) in Portland, OR
• Providers in Portland, OR by specialty
• Lactation Consultant (Non-RN) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.