Provider Demographics
NPI:1407193345
Name:ROBERTSON, KATHLEEN SUSAN (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:ROBERTSON
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 1:863 W 100 N
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-8599
Mailing Address - Country:US
Mailing Address - Phone:317-736-8377
Mailing Address - Fax:
Practice Address - Street 1:863 W 100 N
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-8599
Practice Address - Country:US
Practice Address - Phone:317-736-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10117612174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN