Provider Demographics
NPI:1255101689
Name:O'DRISCOLL, CHAELENE MIA (IBCLC)
Entity type:Individual
Prefix:
First Name:CHAELENE
Middle Name:MIA
Last Name:O'DRISCOLL
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 1:2271 CLEO ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80229-5615
Mailing Address - Country:US
Mailing Address - Phone:720-219-8691
Mailing Address - Fax:
Practice Address - Street 1:2271 CLEO ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80229-5615
Practice Address - Country:US
Practice Address - Phone:720-799-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COL-313584174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN