Healthcare Provider Details

I. General information

NPI: 1417546359
Provider Name (Legal Business Name): SKILLED LACTATION SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26711 WOODWARD AVE STE LLA
HUNTINGTON WOODS MI
48070-1364
US

IV. Provider business mailing address

26711 WOODWARD AVE STE LLA
HUNTINGTON WOODS MI
48070-1364
US

V. Phone/Fax

Practice location:
  • Phone: 248-688-0334
  • Fax:
Mailing address:
  • Phone: 248-688-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: KAITLYN SAGRITALO
Title or Position: CO-OWNER
Credential: CLC
Phone: 248-688-0334