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General NPI Number Information
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NPI Number | 1134781255
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Entity Type | Individual
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Provider Name | KACI GODBEHERE CLC
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Gender | Female
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Dates
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Enumeration Date | 06/29/2019
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Last Update Date | 06/29/2019
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Provider Practice Location Address
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Address Line | 1303 W MAPLE ST STE 105
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City | NORTH CANTON
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State | OH
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Zip | 44720-2858
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Country | US
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Telephone | 330-310-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 719 TAYLOR ST SW
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City | MASSILLON
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State | OH
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Zip | 44647-7726
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Country | US
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Telephone | 330-809-6106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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