Provider Demographics
NPI:1093543134
Name:MOTHERHOOD UNTAMED LACTATION & EDUCATION
Entity type:Organization
Organization Name:MOTHERHOOD UNTAMED LACTATION & EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:970-235-0045
Mailing Address - Street 1:2718 STOCKBURY DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9696
Mailing Address - Country:US
Mailing Address - Phone:970-219-0171
Mailing Address - Fax:
Practice Address - Street 1:2601 S LEMAY AVE UNIT 25
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2247
Practice Address - Country:US
Practice Address - Phone:970-235-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty