Provider Demographics
NPI:1487220034
Name:YORK, KATHRYN (CLC, C-FSD BADT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:CLC, C-FSD BADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-2923
Mailing Address - Country:US
Mailing Address - Phone:734-558-8738
Mailing Address - Fax:
Practice Address - Street 1:103 N PARK ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-2923
Practice Address - Country:US
Practice Address - Phone:734-558-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
323010174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
323010OtherALPP ID NUMBER