=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740070176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTELLELACT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2147 175TH ST APT 7
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60438-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-845-8546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 E 162ND ST # 1099
-----------------------------------------------------
City | SOUTH HOLLAND
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60473-2471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-845-8546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ LACTATION CONSULTANT
-----------------------------------------------------
Name | NATASHA BEAUCHAMP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-845-8546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------