Provider Demographics
NPI:1023876687
Name:LATCHED LAKE COUNTRY LLC
Entity type:Organization
Organization Name:LATCHED LAKE COUNTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, RN, IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SZALACINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, IBCLC, CLC
Authorized Official - Phone:262-204-7574
Mailing Address - Street 1:1380 ORCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-6503
Mailing Address - Country:US
Mailing Address - Phone:262-204-7574
Mailing Address - Fax:
Practice Address - Street 1:W307N1497 GOLF RD STE 102
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2112
Practice Address - Country:US
Practice Address - Phone:262-204-7574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty