Healthcare Provider Details

I. General information

NPI: 1932934320
Provider Name (Legal Business Name): KAYLEE COSTA IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 KENT ST APT 3
QUINCY MA
02169-6490
US

IV. Provider business mailing address

65 KENT ST APT 3
QUINCY MA
02169-6490
US

V. Phone/Fax

Practice location:
  • Phone: 617-302-6963
  • Fax:
Mailing address:
  • Phone: 617-302-6963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW11514
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberLC-LC-10272599
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: