Provider Demographics
NPI:1497252852
Name:KENOE, KATIE LYNN (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:KENOE
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 N ARLINGTON HEIGHTS RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4825
Mailing Address - Country:US
Mailing Address - Phone:847-253-3600
Mailing Address - Fax:847-253-3912
Practice Address - Street 1:1430 N ARLINGTON HEIGHTS RD STE 210
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4825
Practice Address - Country:US
Practice Address - Phone:847-253-3600
Practice Address - Fax:847-253-3912
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-119167163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty