Healthcare Provider Details

I. General information

NPI: 1497677850
Provider Name (Legal Business Name): BLOOMING MOTHER LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 SCOTT RD
YORK PA
17403-9569
US

IV. Provider business mailing address

135 SCOTT RD
YORK PA
17403-9569
US

V. Phone/Fax

Practice location:
  • Phone: 717-912-8848
  • Fax:
Mailing address:
  • Phone: 717-912-8848
  • 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: MRS. KATHRYN KAVJIAN
Title or Position: OWNER
Credential: CLC
Phone: 484-619-1220