Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 41582 | IL |
NPI | 1326579061 |
---|---|
Provider Name | Amy Bogseth |
First Address | Wauconda, IL 60084-5006 |
Second Address | Wauconda, IL 60084-5006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2017 |
Last Update Date | 24/03/2017 |