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General NPI Number Information
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NPI Number | 1942617311
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Entity Type | Individual
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Provider Name | KERRY FAIRCHILD R.D.,LD.,IBCLC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 506 NORWICH DR
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-4245
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Country | US
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Telephone | 440-590-1883
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Fax |
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Provider Business Mailing Address
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Address Line | 506 NORWICH DR
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-4245
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Country | US
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Telephone | 440-590-1883
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD4826
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 11212511
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License Number State | OH
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