Provider Demographics
NPI:1356146807
Name:LACY, KAIA (CLC)
Entity type:Individual
Prefix:
First Name:KAIA
Middle Name:
Last Name:LACY
Suffix:
Gender:
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N AVENIDA CALMA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2249
Mailing Address - Country:US
Mailing Address - Phone:520-955-1729
Mailing Address - Fax:
Practice Address - Street 1:721 NEVADA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8079
Practice Address - Country:US
Practice Address - Phone:909-572-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33054174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN