Kathleen June Bousu, RN IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

1180068 Issued in MN

Practice address

7909 Quincy St NE
Spring Lake Park, MN 55432-1974

Phone

(763) 342-1752

NPI assigned

Nov 6, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wellspring Lactation LLC

  • Health Service Clinic/Center
  • Hanover, MN
  • NPI 1558026385
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636156800000",
    "number": "1467117200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7909 QUINCY ST NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554321974",
            "telephone_number": "763-342-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7909 QUINCY ST NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554321974",
            "telephone_number": "763-342-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSU",
        "first_name": "KATHLEEN",
        "middle_name": "JUNE",
        "credential": "RN IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-06",
        "last_updated": "2021-11-06",
        "certification_date": "2021-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "MN",
            "license": "1180068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arise Orthotics & Prosthetics, Inc.
• Arise Orthotics & Prosthetics, Inc.
• Martha R Arlandson, ED.S., NCSP
• Muath A Asamarai, D.D.S.
• Mujahid Abdulwahab Asamarai
• Vednita Carter, MD
• Central Chiropractic & Acupuncture, P.a.
• Alexandra Kathryn Chapman, MA, LMFT
• Aaron Jonathan Close, LPCC, LADC
• Kyle Partridge Cold

• Lactation Consultant (Registered Nurse) in Spring Lake Park, MN
• Providers in Spring Lake Park, MN by specialty
• Lactation Consultant (Registered Nurse) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.