Healthcare Provider Details

I. General information

NPI: 1942764428
Provider Name (Legal Business Name): LV LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10577 ACACIA PARK PL
LAS VEGAS NV
89135-1243
US

IV. Provider business mailing address

10577 ACACIA PARK PL
LAS VEGAS NV
89135-1243
US

V. Phone/Fax

Practice location:
  • Phone: 702-919-6519
  • Fax:
Mailing address:
  • Phone: 702-919-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: LAUREN E FREY
Title or Position: OWNER
Credential: M.A., CCC-SLP, IBCLC
Phone: 702-919-6519