Provider Demographics
NPI:1093278103
Name:LANG, KALLYN ANN (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:KALLYN
Middle Name:ANN
Last Name:LANG
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 873083
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-3083
Mailing Address - Country:US
Mailing Address - Phone:907-978-1343
Mailing Address - Fax:
Practice Address - Street 1:3851 S UPPER MEADOW CIRCLE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-9962
Practice Address - Country:US
Practice Address - Phone:907-978-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKL-150012174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN