Healthcare Provider Details

I. General information

NPI: 1386354686
Provider Name (Legal Business Name): THE LACTATION CO. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W TAYLOR ST # 233
CHICAGO IL
60607-4623
US

IV. Provider business mailing address

1440 W TAYLOR ST # 233
CHICAGO IL
60607-4623
US

V. Phone/Fax

Practice location:
  • Phone: 574-315-3196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN SZERSZEN
Title or Position: AGENT
Credential:
Phone: 574-315-3196