Healthcare Provider Details

I. General information

NPI: 1497079602
Provider Name (Legal Business Name): BALDWIN LACTATION CONSULTANT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 OAKWOOD DR
RACINE WI
53406-5464
US

IV. Provider business mailing address

3338 OAKWOOD DR
RACINE WI
53406-5464
US

V. Phone/Fax

Practice location:
  • Phone: 262-898-1722
  • Fax:
Mailing address:
  • Phone: 262-898-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number10725859
License Number StateVA

VIII. Authorized Official

Name: MRS. GRACIELA E BALDWIN
Title or Position: INTERNATIONAL BOARD CERTIFIED LACTA
Credential: IBCLC, RLC
Phone: 262-898-1722