MEDICARE: MRS. CAITLIN AHERN IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L-172184	OTHER		INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS

General Provider Information

NPI Number	:	1275106684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAITLIN AHERN IBCLC

Provider Business Mailing Address
First Line	:	5095 N MAPLESTONE AVE
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-6775
Country	:	US
Telephone Number	:	949-751-7473
Fax Number	:

Provider Business Practice Location Address
First Line	:	8601 W EMERALD ST STE 160
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-8297
Country	:	US
Telephone Number	:	208-918-3640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	07/22/2021

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