Provider Demographics
NPI:1245574433
Name:SVIATKO, KELLY (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:SVIATKO
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 1:402 N SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1835
Mailing Address - Country:US
Mailing Address - Phone:847-837-4091
Mailing Address - Fax:
Practice Address - Street 1:402 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1835
Practice Address - Country:US
Practice Address - Phone:847-837-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN