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General NPI Number Information
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NPI Number | 1467147074
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Entity Type | Organization
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Legal Business Name | ST CHARLES LACTATION CARE & SUPPORT LLC
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 1423 N 2ND ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2107
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Country | US
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Telephone | 636-306-3410
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Fax | 636-206-8193
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Provider Business Mailing Address
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Address Line | 3104 WATERWHEEL PL
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2433
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Country | US
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Telephone | 773-354-1853
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Fax | 636-206-8193
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Authorized Official
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Title or Position | OWNER, LACTATION CONSULTANT
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Name | JOHANNA IWASZKOWIEC
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Credential | IBCLC
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Telephone | 773-354-1853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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