Healthcare Provider Details

I. General information

NPI: 1164017190
Provider Name (Legal Business Name): LACTATION CONSULTATION & MAINTAINING WELLNESS, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PACIFIC AVE SE
OLYMPIA WA
98506-4753
US

IV. Provider business mailing address

4026 61ST CT SW
OLYMPIA WA
98512-7028
US

V. Phone/Fax

Practice location:
  • Phone: 360-292-5146
  • Fax: 360-252-8855
Mailing address:
  • Phone: 360-292-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH CASSIDY
Title or Position: PRESIDENT
Credential: RN, IBCLC
Phone: 360-292-5146