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General NPI Number Information
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NPI Number | 1164234886
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Entity Type | Individual
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Provider Name | KELLEEN MERRELL IBCLC
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Gender | Female
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 5877 CENTRAL AVE STE B
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City | PORTAGE
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State | IN
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Zip | 46368-2967
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Country | US
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Telephone | 219-877-8871
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Fax |
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Provider Business Mailing Address
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Address Line | 9 BROWNING LN
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City | VALPARAISO
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State | IN
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Zip | 46383-7414
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Country | US
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Telephone | 219-877-8871
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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 | L-316762
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License Number State | IN
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