Organization
MOMS LACTATION RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BECK IBCLC (CO-MANAGER)
(815) 222-4596
Entity
Organization
Contact information
Practice address
506 N ELIDA, WINNEBAGO, IL 61088
(815) 222-4596
Mailing address
984 WESTRIDGE DR., ROCKFORD, IL 61102
(815) 222-4596
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821569120
—
IL
05
—
187065250
—
IL
Enumeration date
12/28/2018
Last updated
12/28/2018
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