Healthcare Provider Details

I. General information

NPI: 1679062194
Provider Name (Legal Business Name): CONNECTIONS LACTATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 HENDERSON ST
WEST LAFAYETTE IN
47906-1540
US

IV. Provider business mailing address

1402 DURHAM DR
CRAWFORDSVILLE IN
47933-3510
US

V. Phone/Fax

Practice location:
  • Phone: 765-267-1977
  • Fax: 888-971-3923
Mailing address:
  • Phone: 765-267-1977
  • Fax: 888-971-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-127002
License Number StateIN

VIII. Authorized Official

Name: BREA CARLSON
Title or Position: OWNER, LACTATION CONSULTANT, SLP
Credential: CCC-SLP, IBCLC
Phone: 765-267-1977