Provider Demographics
NPI:1932577442
Name:LEONARD, KRISTYN (IBCLC, CLC)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:IBCLC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COLUMBIANA DR STE 116
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7782
Mailing Address - Country:US
Mailing Address - Phone:803-250-5723
Mailing Address - Fax:803-598-0100
Practice Address - Street 1:800 COLUMBIANA DR STE 116
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7782
Practice Address - Country:US
Practice Address - Phone:803-250-5723
Practice Address - Fax:803-598-0100
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-301434OtherIBLCE
36615OtherALPP
13972350OtherCAQH