Healthcare Provider Details

I. General information

NPI: 1154066512
Provider Name (Legal Business Name): SYDNEY PETERS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYDNEY MCCOLLUM

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 DEADWOOD AVE
RAPID CITY SD
57702-0379
US

IV. Provider business mailing address

1329 EGLIN ST STE 200 PMB 311
RAPID CITY SD
57701
US

V. Phone/Fax

Practice location:
  • Phone: 605-416-1778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-310202
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: