# MOMS LACTATION RESOURCE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255803466
- **Authorized official:** JENNIFER BECK IBCLC (CO-MANAGER)
- **Authorized official phone:** (815) 222-4596

## Contact information

- **Practice address:** 506 N ELIDA, WINNEBAGO, IL 61088
- **Practice address phone:** (815) 222-4596
- **Mailing address:** 984 WESTRIDGE DR., ROCKFORD, IL 61102
- **Mailing address phone:** (815) 222-4596

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/28/2018
- **Last updated:** 12/28/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1821569120 | — | IL |
| 05 | — | 187065250 | — | IL |