Healthcare Provider Details

I. General information

NPI: 1598159915
Provider Name (Legal Business Name): CYGNUS LACTATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 847-837-4091
  • Fax: 800-894-1392
Mailing address:
  • Phone: 847-837-4091
  • Fax: 800-894-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEANNE M CYGNUS
Title or Position: PRESIDENT
Credential: IBCLC
Phone: 847-837-4091