Healthcare Provider Details

I. General information

NPI: 1023525870
Provider Name (Legal Business Name): KELLY ANN LAFFERTY IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 ZUNI ST
DENVER CO
80211-3827
US

IV. Provider business mailing address

1691 W CANAL CIR UNIT 1133
LITTLETON CO
80120-4557
US

V. Phone/Fax

Practice location:
  • Phone: 720-763-5265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL132862
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: