Provider Demographics
NPI:1093587339
Name:BEAUCHAMP, NATASHA (IBCLC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:BEAUCHAMP
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 1:930 E 162ND ST # 1099
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2442
Mailing Address - Country:US
Mailing Address - Phone:708-965-4468
Mailing Address - Fax:
Practice Address - Street 1:2147 175TH ST APT 7
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1623
Practice Address - Country:US
Practice Address - Phone:708-845-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILALPP-340176101Y00000X
ILL-316050174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No101Y00000XBehavioral Health & Social Service ProvidersCounselor