MEDICARE: WILLOW LACTATION PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WL0100X	Lactation Consultant (Registered Nurse)
2	363LW0102X	Women's Health Nurse Practitioner
3	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1225828544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW LACTATION PLLC

Provider Business Mailing Address
First Line	:	7225 N ORIOLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-4253
Country	:	US
Telephone Number	:	309-242-8447
Fax Number	:

Provider Business Practice Location Address
First Line	:	7225 N ORIOLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-4253
Country	:	US
Telephone Number	:	309-242-8447
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARET C JOHNSON
Credential	:	APRN
Telephone Number	:	309-242-8447

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	05/09/2025

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