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General NPI Number Information
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NPI Number | 1609405489
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Entity Type | Individual
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Provider Name | KATHLEEN KENNEDY RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 7150 SW DARTMOUTH ST
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City | TIGARD
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State | OR
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Zip | 97223-7614
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Country | US
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Telephone | 503-968-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 8112 SW 56TH AVE
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City | PORTLAND
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State | OR
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Zip | 97219-3223
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Country | US
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Telephone | 503-780-3172
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 200440164RN
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License Number State | OR
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