Provider Demographics
NPI:1609516293
Name:BASKIN, KIARA (CD, CLC)
Entity Type:Individual
Prefix:MISS
First Name:KIARA
Middle Name:
Last Name:BASKIN
Suffix:
Gender:F
Credentials:CD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 GRIGGS ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2824
Mailing Address - Country:US
Mailing Address - Phone:616-633-4383
Mailing Address - Fax:
Practice Address - Street 1:1340 GRIGGS ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2824
Practice Address - Country:US
Practice Address - Phone:616-633-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174N00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN