Provider Demographics
NPI:1457112666
Name:JONAS, KATHRYN (IBCLC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:JONAS
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 1:61524 SE LORENZO DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3765
Mailing Address - Country:US
Mailing Address - Phone:541-241-6698
Mailing Address - Fax:
Practice Address - Street 1:61524 SE LORENZO DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3765
Practice Address - Country:US
Practice Address - Phone:541-241-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-314367174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN