If you offer free or low cost, or Medi-Cal reimbursable services, you will be listed in the Low Cost, Free or Medi-Cal Reimbursable listings free of charge.

If you have questions on directory application, please contact Louise at ltellalian@BreastfeedLA.org or call 310-274-2272.
If you experience technical difficulty, please contact Amy at ama@BreastfeedLA.org or call 760-929-0325 ext. 20.

It is very important that all the required fields are completed. Incomplete application will not be processed or listed. You can either select to pay by credit card online or mail in check payment upon completing your application.

Please review individual listing format in the 2007 Directory on-line (this will open another window).

Institution / Agency Information:

  
Name of Institution / Clinic / Agency:
 
Address 1:  
Address 2:  
City: State: Zip: - zipcode+4 look up  
Official Contact Person and Title:  
Last Name: MI: First Name: Title:  
Contact Phone Number: --Ext. Business Fax Number: --  
E-Mail:  
Business Hours:  
   
Credentials:  
Name of individual providing lactation services:  
List qualifying credentials:  
LVN  RN  MD  OT  PT  RD  Other: 
Note: Please check the box "Other" if you don't have any credentials.		  
License Number: Expiration Date: (mm/dd/year)  
Lactation Certification:  
IBCLC  Certified Lactation Consultant  Certified Lactation Educator  Certified Lactation Counselor Other:  Note: Please check the box "Other" if you don't have any credentials.  
Organization that issued certification:  
Certification Date: (mm/dd/year)  
Expiration Date: (mm/dd/year)  
   
Please verify the information, then click next to continue.  
 
   
Directory Information:

This information will be used to compile your listing in the 2007 Directory. Please look at the individual listing format in the 2007 Directory online (this will open another window).

If you were listed in 2007, may we use the EXACT same listing?Yes / No

If you were NOT LISTED in 2007, or if you would like to make CHANGES to your 2007 listing, please complete the fields below.

You are limited to six lines of text with 80 spaces on each line.  Please restrict your credentials and services to those relevant to lactation.
You will be listed under the heading in your primary service area.  If you, wish your secondary areas will be named as part of your listing. Entering your home address is optional.

Basic: Listing in the printed Resource Directory and on the Task Force website.
 Basic plus Hyperlink:  Listing in the printed Resource Directory, on the Task Force website and your email and/or website hyperlinked on the Task Force website.
 

  
Name of Institution / Agency:    
Name, credentials of contact person:  
Contact Phone Number: -- Ext:  
Business Hours:  
Address1:    
Address2:  
City: State:   Zip:  - zipcode+4 look up  
Geographic Service Area:    
Services Offered: (Check all that apply)  
Prenatal Group Classes  Post Partum Group ClassesPrivate Instruction  
Consultations:  
Hospital Inpatient  Hospital Outpatient In WIC Center  Clinic Setting 
 Other  		 
Breast Pump:  
Sales  Rental  Pump Parts  Breast Feeding Supplies  
Special Breastfeeding Services  
Do you accept credit cards? Yes  No  
Do you have a web site? Yes No  If Yes, web address:  
Do you provide Free Services  MediCal Reimbursable Services  
Do you offer service in language's other then English? Yes No
If Yes, what language(s): 		 
Do you provide services on Saturday  Sunday  Evenings  
   
If you provide free, Medi-Cal reimbursable, or very low cost services, you may have a FREE listing in the Free and Medi-Cal listings of the Directory.

If you charge for your services, you will be listed in the fee based Providers of Lactation Services section of the Directory and need to pay the $150.00 subscription fee. You may have your website or email address hyperlinked in the online version of the Directory for an additional $50.00. 		 
   
Please verify the information.  

Please type in your name:

By typing my name here, I certify that all the above information is true and valid.

 

 

 
 

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