Healthcare Provider Details

I. General information

NPI: 1265256804
Provider Name (Legal Business Name): ROSE DUFFY LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8157 N OSCEOLA AVE
NILES IL
60714-2947
US

IV. Provider business mailing address

8157 N OSCEOLA AVE
NILES IL
60714-2947
US

V. Phone/Fax

Practice location:
  • Phone: 815-529-8756
  • Fax:
Mailing address:
  • Phone: 815-529-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: ROSE DUFFY
Title or Position: OWNER
Credential: OTR/L
Phone: 815-529-8756