Healthcare Provider Details

I. General information

NPI: 1457902553
Provider Name (Legal Business Name): LACTATION LINK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 SICILY LANE
HIGHLAND UT
84003
US

IV. Provider business mailing address

5524 SICILY LANE
HIGHLAND UT
84003
US

V. Phone/Fax

Practice location:
  • Phone: 801-367-7005
  • Fax: 888-755-7189
Mailing address:
  • Phone: 801-367-7005
  • Fax: 888-755-7189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LINDSEY SHIPLEY
Title or Position: OWNER
Credential: RN, IBCLC
Phone: 801-367-7005