Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-303480 | IL |
NPI | 1386318012 |
---|---|
Provider Name | Mrs. Kelly Jean Sieczkowski |
First Address | Streamwood, IL 60107-1862 |
Second Address | Downers Grove, IL 60515-1008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 05/08/2021 |