Provider Demographics
NPI:1770027914
Name:BAILEY, KAITLIN SHEA (MS, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:SHEA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07732-1535
Mailing Address - Country:US
Mailing Address - Phone:908-601-8479
Mailing Address - Fax:
Practice Address - Street 1:59 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07732-1535
Practice Address - Country:US
Practice Address - Phone:908-601-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
NJL-94668174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education