Provider Demographics
NPI:1457002511
Name:KIMMONS, LASHANNA (IBCLC)
Entity Type:Individual
Prefix:
First Name:LASHANNA
Middle Name:
Last Name:KIMMONS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:LASHANNA
Other - Middle Name:
Other - Last Name:NEELEY-KIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1078
Mailing Address - Country:US
Mailing Address - Phone:708-238-7681
Mailing Address - Fax:
Practice Address - Street 1:143 INDIANA ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1078
Practice Address - Country:US
Practice Address - Phone:708-238-7681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty