Provider Demographics
NPI:1255768925
Name:STOCK, KIRSTEN WHITLOW (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:WHITLOW
Last Name:STOCK
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 1:261 FOXGLOVE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1992
Mailing Address - Country:US
Mailing Address - Phone:541-915-4322
Mailing Address - Fax:
Practice Address - Street 1:261 FOXGLOVE AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1992
Practice Address - Country:US
Practice Address - Phone:541-915-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11240270174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN