Provider Demographics
NPI:1619187713
Name:PRADO, SUSAN M (IBCLC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PRADO
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5325
Mailing Address - Country:US
Mailing Address - Phone:630-740-6652
Mailing Address - Fax:
Practice Address - Street 1:2421 ROYAL DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5325
Practice Address - Country:US
Practice Address - Phone:630-620-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104-20977174400000X
IL104-20977174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist