Healthcare Provider Details

I. General information

NPI: 1699362459
Provider Name (Legal Business Name): JANICE SEDLACK IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S LAKE ST STE B
MUNDELEIN IL
60060-4255
US

IV. Provider business mailing address

556 BIRCH RD
WOODSTOCK IL
60098-2753
US

V. Phone/Fax

Practice location:
  • Phone: 847-837-4091
  • Fax:
Mailing address:
  • Phone: 847-830-3351
  • 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:
Title or Position:
Credential:
Phone: