MEDICARE: SOULLABOR LLC

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)

General Provider Information

NPI Number	:	1770437394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOULLABOR LLC

Provider Business Mailing Address
First Line	:	1016 MERCURY DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 MERCURY DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7739
Country	:	US
Telephone Number	:	720-530-4308
Fax Number	:	720-530-4308

Authorized Official
Title or Position	:	LACTATION CONSULTANT
Name	:	MARA HEIDEN
Credential	:	IBCLC
Telephone Number	:	720-530-4308

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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Directions to “SOULLABOR LLC ” Practice Location

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