Provider Demographics
NPI:1184442204
Name:KOLL, KATIE (IBCLC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KOLL
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:FICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1515
Mailing Address - Country:US
Mailing Address - Phone:630-927-2728
Mailing Address - Fax:
Practice Address - Street 1:223 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1515
Practice Address - Country:US
Practice Address - Phone:630-927-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-315863174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN