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General NPI Number Information
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NPI Number | 1518421650
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Entity Type | Organization
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Legal Business Name | THE LACTATION CLINIC OF SOUTHEAST WISCONSIN, INC
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 530 N 108TH PL STE 100
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City | WAUWATOSA
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State | WI
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Zip | 53226-4253
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Country | US
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Telephone | 414-628-7659
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Fax |
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Provider Business Mailing Address
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Address Line | 530 N 108TH PL STE 100
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City | WAUWATOSA
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State | WI
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Zip | 53226-4253
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | DR. KRISTEN LEE
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Credential | DC, CLC
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Telephone | 414-628-7659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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