Provider Demographics
NPI:1598227514
Name:DEWAR, KATHRYN JANET (CPM, IBCLC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANET
Last Name:DEWAR
Suffix:
Gender:F
Credentials:CPM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N BINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8676
Mailing Address - Country:US
Mailing Address - Phone:207-491-3783
Mailing Address - Fax:
Practice Address - Street 1:5 PARK ST STE 3C
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1169
Practice Address - Country:US
Practice Address - Phone:503-961-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
VT107.0129904175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No174N00000XOther Service ProvidersLactation Consultant, Non-RN