Healthcare Provider Details

I. General information

NPI: 1790576791
Provider Name (Legal Business Name): SERENITY LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 W RIVERDALE RD
RIVERDALE UT
84405-3715
US

IV. Provider business mailing address

51 W ALABAMA DR UNIT A1
MIDVALE UT
84047-7869
US

V. Phone/Fax

Practice location:
  • Phone: 385-456-2235
  • Fax:
Mailing address:
  • Phone: 701-840-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: MEGAN JACOBSON
Title or Position: CHIROPRACTOR, LACTATION CONSULTANT
Credential: DC, IBCLC
Phone: 701-840-4986