Healthcare Provider Details

I. General information

NPI: 1528913365
Provider Name (Legal Business Name): LACTATION CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 W LAKEWOOD BLVD
HOLLAND MI
49424-6221
US

IV. Provider business mailing address

1256 W LAKEWOOD BLVD
HOLLAND MI
49424-6221
US

V. Phone/Fax

Practice location:
  • Phone: 917-336-7013
  • Fax: 855-827-6054
Mailing address:
  • Phone: 917-336-7013
  • Fax: 855-827-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA CHRISTOPHER
Title or Position: CEO
Credential: IBCLC
Phone: 203-512-7000