Provider Demographics
NPI:1598159915
Name:CYGNUS LACTATION SERVICES LLC
Entity Type:Organization
Organization Name:CYGNUS LACTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CYGNUS
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:847-837-4091
Mailing Address - Street 1:1500 S LAKE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4255
Mailing Address - Country:US
Mailing Address - Phone:847-837-4091
Mailing Address - Fax:800-894-1392
Practice Address - Street 1:1500 S LAKE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4255
Practice Address - Country:US
Practice Address - Phone:847-837-4091
Practice Address - Fax:800-894-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12748712OtherCAQH
IL12431979OtherCAQH