Provider Demographics
NPI:1942902887
Name:WOLAK, KAREN (IBCLC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WOLAK
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 1:1747 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5419
Mailing Address - Country:US
Mailing Address - Phone:734-731-1383
Mailing Address - Fax:
Practice Address - Street 1:1747 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5419
Practice Address - Country:US
Practice Address - Phone:734-731-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-152529174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN