Provider Demographics
NPI:1225814262
Name:CAILLOUETTE, CARRIE CHRISTINE (IBCLC, BA, M ED)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:CHRISTINE
Last Name:CAILLOUETTE
Suffix:
Gender:F
Credentials:IBCLC, BA, M ED
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 507
Mailing Address - Street 2:
Mailing Address - City:VALLEY FORD
Mailing Address - State:CA
Mailing Address - Zip Code:94972-0507
Mailing Address - Country:US
Mailing Address - Phone:415-699-5767
Mailing Address - Fax:
Practice Address - Street 1:14270 VALLEY FORD ROAD
Practice Address - Street 2:
Practice Address - City:VALLEY FORD
Practice Address - State:CA
Practice Address - Zip Code:94972
Practice Address - Country:US
Practice Address - Phone:415-699-5767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-308275174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN