Provider Demographics
NPI:1336456037
Name:MADAJ, JANE (IBCLC,RLC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MADAJ
Suffix:
Gender:F
Credentials:IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23W735 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2955
Mailing Address - Country:US
Mailing Address - Phone:630-582-4259
Mailing Address - Fax:630-582-4259
Practice Address - Street 1:23W735 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2955
Practice Address - Country:US
Practice Address - Phone:630-582-4259
Practice Address - Fax:630-582-4259
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-14894174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN