Provider Demographics
NPI:1700095205
Name:LEBBING, KATY (BS, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:KATY
Middle Name:
Last Name:LEBBING
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 CALDUTO CIR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3484
Mailing Address - Country:US
Mailing Address - Phone:630-833-1248
Mailing Address - Fax:
Practice Address - Street 1:519 CALDUTO CIR
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-3484
Practice Address - Country:US
Practice Address - Phone:630-833-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA197-14079174400000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist