Healthcare Provider Details

I. General information

NPI: 1043657018
Provider Name (Legal Business Name): CYGNUS LACTATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N SEYMOUR AVE
MUNDELEIN IL
60060-1835
US

IV. Provider business mailing address

402 N SEYMOUR AVE
MUNDELEIN IL
60060-1835
US

V. Phone/Fax

Practice location:
  • Phone: 847-837-4091
  • Fax:
Mailing address:
  • Phone: 847-837-4091
  • 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: JEANNE CYGNUS
Title or Position: PRESIDENT, IBCLC, RLC
Credential:
Phone: 847-837-4091