Provider Demographics
NPI:1902606288
Name:MONTCALM, MEGHAN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:MONTCALM
Suffix:
Gender:
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7059 N MOBILE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-1023
Mailing Address - Country:US
Mailing Address - Phone:773-350-9619
Mailing Address - Fax:
Practice Address - Street 1:7059 N MOBILE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-1023
Practice Address - Country:US
Practice Address - Phone:773-350-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041397176163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant