Healthcare Provider Details

I. General information

NPI: 1700095205
Provider Name (Legal Business Name): KATY LEBBING B.S., I.B.C.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 CALDUTO CIR
VILLA PARK IL
60181-3484
US

IV. Provider business mailing address

519 CALDUTO CIR
VILLA PARK IL
60181-3484
US

V. Phone/Fax

Practice location:
  • Phone: 630-833-1248
  • Fax:
Mailing address:
  • Phone: 630-833-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number197-14079
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: