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General NPI Number Information
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NPI Number | 1386553097
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Entity Type | Organization
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Legal Business Name | MOMMA'S MILK LACTATION SUPPORT LLC
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Dates
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Enumeration Date | 09/07/2026
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Last Update Date | 09/07/2026
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Provider Practice Location Address
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Address Line | 3640 NATALIE DR
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City | GROVE CITY
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State | OH
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Zip | 43123-9462
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Country | US
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Telephone | 614-370-9141
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Fax |
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Provider Business Mailing Address
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Address Line | 3640 NATALIE DR
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City | GROVE CITY
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State | OH
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Zip | 43123-9462
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Country | US
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Telephone | 614-370-9141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTNEY CLARK
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Credential | BSN RN IBCLC
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Telephone | 614-370-9141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WM0102X
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Taxonomy Name | Maternal Newborn Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WW0101X
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Taxonomy Name | Ambulatory Women's Health Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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