Provider Demographics
NPI:1467887380
Name:KIEHL, LAURA M (IBCLC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:KIEHL
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 1:5226 WYNDROOK ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5043
Mailing Address - Country:US
Mailing Address - Phone:940-230-1521
Mailing Address - Fax:
Practice Address - Street 1:5226 WYNDROOK ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5043
Practice Address - Country:US
Practice Address - Phone:940-230-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10988868163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant