Healthcare Provider Details

I. General information

NPI: 1831028646
Provider Name (Legal Business Name): MELANIE HENSTROM LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 S ORCHARD ST STE 104
BOISE ID
83705-3794
US

IV. Provider business mailing address

6689 E PLAYWRIGHT DR
BOISE ID
83716-5831
US

V. Phone/Fax

Practice location:
  • Phone: 971-235-8773
  • Fax:
Mailing address:
  • Phone: 971-235-8773
  • Fax: 208-779-4921

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: MELANIE HENSTROM
Title or Position: LACTATION CONSULTANT
Credential: IBCLC
Phone: 971-235-8773