Provider Demographics
NPI:1801568001
Name:ST LACTATION SERVICES, LLC
Entity type:Organization
Organization Name:ST LACTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, IBCLC
Authorized Official - Phone:508-203-7797
Mailing Address - Street 1:62 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2516
Mailing Address - Country:US
Mailing Address - Phone:508-203-7797
Mailing Address - Fax:833-440-1417
Practice Address - Street 1:218 SHREWSBURY ST STE 201B
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4652
Practice Address - Country:US
Practice Address - Phone:508-203-7797
Practice Address - Fax:833-440-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty