Provider Demographics
NPI:1922764992
Name:MILK GUIDE LACTATION OF TENNESSEE LLC
Entity Type:Organization
Organization Name:MILK GUIDE LACTATION OF TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SZERSZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-315-3196
Mailing Address - Street 1:10275 PEOTONE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3304
Practice Address - Country:US
Practice Address - Phone:574-315-3196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0012364OtherSTATE OF TN (SOS CONTROL #)