Provider Demographics
NPI:1154197358
Name:PROSPECT LACTATION CARE LLC
Entity type:Organization
Organization Name:PROSPECT LACTATION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIJAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:224-232-9107
Mailing Address - Street 1:124 S WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2937
Mailing Address - Country:US
Mailing Address - Phone:224-232-9107
Mailing Address - Fax:
Practice Address - Street 1:657 E GOLF RD STE 301
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4071
Practice Address - Country:US
Practice Address - Phone:224-366-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty