Provider Demographics
NPI:1326439712
Name:RYAN, KERRY MICHELE (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:MICHELE
Last Name:RYAN
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 1:175 SILVERMINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-1610
Mailing Address - Country:US
Mailing Address - Phone:203-981-8207
Mailing Address - Fax:
Practice Address - Street 1:175 SILVERMINE AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-1610
Practice Address - Country:US
Practice Address - Phone:203-981-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11159274174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula