Provider Demographics
NPI:1760250328
Name:GODDARD, KAYLEE (IBCLC)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:GODDARD
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 1:607 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COLWICH
Mailing Address - State:KS
Mailing Address - Zip Code:67030-9644
Mailing Address - Country:US
Mailing Address - Phone:316-214-5697
Mailing Address - Fax:
Practice Address - Street 1:123 N TYLER RD STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3726
Practice Address - Country:US
Practice Address - Phone:316-202-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSL-314162174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN