Provider Demographics
NPI:1568131217
Name:SMITH, RILEE ANNE (IBCLC)
Entity Type:Individual
Prefix:
First Name:RILEE
Middle Name:ANNE
Last Name:SMITH
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 1:804 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-3956
Mailing Address - Country:US
Mailing Address - Phone:920-639-7574
Mailing Address - Fax:
Practice Address - Street 1:804 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3956
Practice Address - Country:US
Practice Address - Phone:920-639-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-304034174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN