Healthcare Provider Details

I. General information

NPI: 1053615054
Provider Name (Legal Business Name): VALERIA LISA KEHOE IBCLC, RLC, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 WILLIAMSBURG RD
ROCKFORD IL
61107-2445
US

IV. Provider business mailing address

1745 WILLIAMSBURG RD
ROCKFORD IL
61107-2445
US

V. Phone/Fax

Practice location:
  • Phone: 815-988-4292
  • Fax:
Mailing address:
  • Phone: 815-988-4292
  • 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 Code174400000X
TaxonomySpecialist
License Number11035024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: