Healthcare Provider Details

I. General information

NPI: 1326974155
Provider Name (Legal Business Name): LAKE COUNTRY BIRTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 N MORGAN RD
OCONOMOWOC WI
53066-9136
US

IV. Provider business mailing address

1365 N MORGAN RD
OCONOMOWOC WI
53066-9136
US

V. Phone/Fax

Practice location:
  • Phone: 224-659-6722
  • Fax: 808-204-1170
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: ALECIA JONES
Title or Position: OWNER
Credential: CLD
Phone: 224-659-6722