Healthcare Provider Details

I. General information

NPI: 1962865295
Provider Name (Legal Business Name): KATTE SMITH IBCLC, CCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2864 TIFFANY WEST WAY
SACRAMENTO CA
95827-1416
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2866
  • Fax:
Mailing address:
  • Phone: 916-579-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-36452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: