Provider Demographics
NPI:1659161081
Name:KIMMONS LACTATION SERVICES LLC
Entity type:Organization
Organization Name:KIMMONS LACTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:LASHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:708-578-5056
Mailing Address - Street 1:143 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1078
Mailing Address - Country:US
Mailing Address - Phone:708-578-5056
Mailing Address - Fax:
Practice Address - Street 1:143 INDIANA ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1078
Practice Address - Country:US
Practice Address - Phone:708-578-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty