Provider Demographics
NPI:1154145969
Name:ROSE DUFFY LACTATION LLC
Entity type:Organization
Organization Name:ROSE DUFFY LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CLC
Authorized Official - Phone:815-529-8756
Mailing Address - Street 1:8157 N OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2947
Mailing Address - Country:US
Mailing Address - Phone:815-529-8756
Mailing Address - Fax:
Practice Address - Street 1:8157 N OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2947
Practice Address - Country:US
Practice Address - Phone:815-529-8756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty