Provider Demographics
NPI:1164944948
Name:STAYING ABREAST LACTATION TEAM LLC
Entity Type:Organization
Organization Name:STAYING ABREAST LACTATION TEAM LLC
Other - Org Name:THE SALT BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALLING
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, IBCLC
Authorized Official - Phone:816-294-5001
Mailing Address - Street 1:12320 SE STATE ROUTE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7413
Mailing Address - Country:US
Mailing Address - Phone:816-294-5001
Mailing Address - Fax:
Practice Address - Street 1:12320 SE STATE ROUTE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7413
Practice Address - Country:US
Practice Address - Phone:816-294-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL-66864163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty