=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215728761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAMA BEAR LACTATION CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2025
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1813 BRACKETT AVE UNIT A
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-5041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-204-4060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3402 DAVID DR
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-204-4060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER, OWNER
-----------------------------------------------------
Name | MS. JENNIFER J HAFELE
-----------------------------------------------------
Credential | M.ED., IBCLC
-----------------------------------------------------
Telephone | 715-204-4060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------