MEDICARE: EQUALLY EXPRESSED, 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	:	1932854627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUALLY EXPRESSED, LLC

Provider Business Mailing Address
First Line	:	800 TURNPIKE ST STE 300
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6156
Country	:	US
Telephone Number	:	978-228-1125
Fax Number	:	978-608-8324

Provider Business Practice Location Address
First Line	:	790 TURNPIKE ST STE 110
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6129
Country	:	US
Telephone Number	:	978-258-6491
Fax Number	:	978-608-8324

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JESSICA M PIMENTEL
Credential	:	CLC, CBS IBCLC
Telephone Number	:	978-228-1125

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	04/16/2025

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