Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11281557 | IN |
NPI | 1023407285 |
---|---|
Provider Name | Mrs. Kelly Slattery |
First Address | Columbus, IN 47203-2459 |
Second Address | Columbus, IN 47203-2459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2015 |
Last Update Date | 12/01/2015 |