Healthcare Provider Details

I. General information

NPI: 1275094583
Provider Name (Legal Business Name): BREATHING SPACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 14TH ST SE
WASHINGTON DC
20003-3014
US

IV. Provider business mailing address

713 14TH ST SE
WASHINGTON DC
20003-3014
US

V. Phone/Fax

Practice location:
  • Phone: 202-599-0434
  • Fax:
Mailing address:
  • Phone: 202-599-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER M MUELLER
Title or Position: OWNER
Credential: IBCLC
Phone: 202-599-0434