Provider Demographics
NPI:1205514841
Name:CLARK, KATHRYN ELEANOR (IBCLC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELEANOR
Last Name:CLARK
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 1:6356 S NEWLAND CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3862
Mailing Address - Country:US
Mailing Address - Phone:720-285-8889
Mailing Address - Fax:
Practice Address - Street 1:6356 S NEWLAND CT
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3862
Practice Address - Country:US
Practice Address - Phone:720-285-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN