Provider Demographics
NPI:1649052119
Name:ILES, CASEY L (CLC)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:L
Last Name:ILES
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 HIGHWAY 26
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-7256
Mailing Address - Country:US
Mailing Address - Phone:337-375-6482
Mailing Address - Fax:
Practice Address - Street 1:3922 HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-7256
Practice Address - Country:US
Practice Address - Phone:337-375-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA339306174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN