Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-62086 | ID |
NPI | 1235780990 |
---|---|
Provider Name | Katie Jo Leask |
First Address | Idaho Falls, ID 83401-3821 |
Second Address | Idaho Falls, ID 83404-7407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2019 |
Last Update Date | 24/09/2019 |