Provider Demographics
NPI:1154859965
Name:TANNEHILL, KADIE MARIE (CLC)
Entity Type:Individual
Prefix:MRS
First Name:KADIE
Middle Name:MARIE
Last Name:TANNEHILL
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3704
Mailing Address - Country:US
Mailing Address - Phone:314-258-6963
Mailing Address - Fax:
Practice Address - Street 1:2440 EXECUTIVE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5607
Practice Address - Country:US
Practice Address - Phone:636-244-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208839174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN