Provider Demographics
NPI:1598422958
Name:JOHNSTON, KISHA D (IBCLC)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:D
Last Name:JOHNSTON
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 1:13579 SW FEIRING LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1605
Mailing Address - Country:US
Mailing Address - Phone:971-219-3660
Mailing Address - Fax:
Practice Address - Street 1:13579 SW FEIRING LN
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-1605
Practice Address - Country:US
Practice Address - Phone:971-217-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLC-LC-10218435174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN