Provider Demographics
NPI:1720429632
Name:MOTHERFED, LLC
Entity type:Organization
Organization Name:MOTHERFED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC, RLC
Authorized Official - Phone:801-580-4419
Mailing Address - Street 1:PO BOX 522425
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84152-2425
Mailing Address - Country:US
Mailing Address - Phone:801-580-4419
Mailing Address - Fax:
Practice Address - Street 1:PARKVIEW PLAZA ONE 2180 SOUTH 1300 EAST
Practice Address - Street 2:SUITE 600
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4462
Practice Address - Country:US
Practice Address - Phone:801-580-4419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty