MEDICARE: KAYELLEN MARIE YOUNG IBCLC, RLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-32575	CA

General Provider Information

NPI Number	:	1184917031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYELLEN MARIE YOUNG IBCLC, RLC

Provider Business Mailing Address
First Line	:	68165 PERLITA RD
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-5223
Country	:	US
Telephone Number	:	760-567-1606
Fax Number	:

Provider Business Practice Location Address
First Line	:	68165 PERLITA RD
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-5223
Country	:	US
Telephone Number	:	760-567-1606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	11/14/2024

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