Provider Demographics
NPI:1467147074
Name:ST CHARLES LACTATION CARE & SUPPORT LLC
Entity Type:Organization
Organization Name:ST CHARLES LACTATION CARE & SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:IWASZKOWIEC
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:773-354-1853
Mailing Address - Street 1:3104 WATERWHEEL PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2433
Mailing Address - Country:US
Mailing Address - Phone:773-354-1853
Mailing Address - Fax:636-206-8193
Practice Address - Street 1:1423 N 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2107
Practice Address - Country:US
Practice Address - Phone:636-306-3410
Practice Address - Fax:636-206-8193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty