Healthcare Provider Details

I. General information

NPI: 1437004884
Provider Name (Legal Business Name): KRISTIN MORTER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 DEAN ST NE
GRAND RAPIDS MI
49505-4735
US

IV. Provider business mailing address

340 DEAN ST NE
GRAND RAPIDS MI
49505-4735
US

V. Phone/Fax

Practice location:
  • Phone: 616-550-2940
  • Fax:
Mailing address:
  • Phone: 616-550-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberUFAU9LJH
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: