Provider Demographics
NPI:1275106684
Name:AHERN, CAITLIN (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:
Last Name:AHERN
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 1:5095 N MAPLESTONE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6775
Mailing Address - Country:US
Mailing Address - Phone:949-751-7473
Mailing Address - Fax:
Practice Address - Street 1:8601 W EMERALD ST STE 160
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8297
Practice Address - Country:US
Practice Address - Phone:208-918-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-172184OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS