Healthcare Provider Details

I. General information

NPI: 1306406020
Provider Name (Legal Business Name): MAGNOLIA LACTATION CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11857 BRICKSOME AVE STE A
BATON ROUGE LA
70816-5317
US

IV. Provider business mailing address

11857 BRICKSOME AVE STE A
BATON ROUGE LA
70816-5317
US

V. Phone/Fax

Practice location:
  • Phone: 225-230-9054
  • Fax:
Mailing address:
  • Phone: 225-230-9054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WESTERN
Title or Position: OWNER, IBCLC
Credential: RN, IBCLC
Phone: 225-230-9054