# MOMMA'S MILK LACTATION SUPPORT LLC

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

## Provider details

- **NPI number:** 1386553097
- **Authorized official:** COURTNEY CLARK BSN RN IBCLC (OWNER)
- **Authorized official phone:** (614) 370-9141

## Contact information

- **Practice address:** 3640 NATALIE DR, GROVE CITY, OH 43123-9462
- **Practice address phone:** (614) 370-9141
- **Mailing address:** 3640 NATALIE DR, GROVE CITY, OH 43123-9462
- **Mailing address phone:** (614) 370-9141

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 163WL0100X | Lactation Consultant (Registered Nurse) | — | NULL | — |
| 163WL0100X | Lactation Consultant (Registered Nurse) | — | — | — |
| 163WM0102X | Maternal Newborn Registered Nurse | — | NULL | — |
| 163WM0102X | Maternal Newborn Registered Nurse | — | — | — |
| 163WW0101X | Ambulatory Women's Health Care Registered Nurse | — | NULL | — |
| 163WW0101X | Ambulatory Women's Health Care Registered Nurse | — | — | — |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/07/2026
- **Last updated:** 09/07/2026