Healthcare Provider Details

I. General information

NPI: 1700706371
Provider Name (Legal Business Name): FIRST SIP LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PARAMOUNT PKWY
WHEAT RIDGE CO
80215-6615
US

IV. Provider business mailing address

13 PARAMOUNT PKWY
WHEAT RIDGE CO
80215-6615
US

V. Phone/Fax

Practice location:
  • Phone: 702-629-0991
  • Fax:
Mailing address:
  • Phone: 702-629-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: BLAKE WYMAN
Title or Position: AUTHORIZED OFFICIAL
Credential: IBCLC
Phone: 702-629-0991