MEDICARE: BETH ELLEN BEJNAROWICZ IBCLC, POSTPAR DOULA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	11040747	IL
2	374J00000X	Doula	8744	IL

General Provider Information

NPI Number	:	1528357316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ELLEN BEJNAROWICZ IBCLC, POSTPAR DOULA

Provider Business Mailing Address
First Line	:	379 KIM TRL
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2145
Country	:	US
Telephone Number	:	847-987-8079
Fax Number	:

Provider Business Practice Location Address
First Line	:	379 KIM TRL
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2145
Country	:	US
Telephone Number	:	847-987-8079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	11/21/2011

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