=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528913365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREASTFEEDING MEDICINE CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2026
-----------------------------------------------------
Last Update Date | 02/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1256 W LAKEWOOD BLVD
-----------------------------------------------------
City | HOLLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49424-6221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-336-7013
-----------------------------------------------------
Fax | 855-827-6054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1256 W LAKEWOOD BLVD
-----------------------------------------------------
City | HOLLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49424-6221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-336-7013
-----------------------------------------------------
Fax | 855-827-6054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CASSANDRA CHRISTOPHER
-----------------------------------------------------
Credential | IBCLC
-----------------------------------------------------
Telephone | 203-512-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------