MEDICARE: KELSEY R GOLDSTEIN MS, CLC, 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)	ALPP-351338
2	174N00000X	Lactation Consultant (Non-RN)	L-320438

General Provider Information

NPI Number	:	1396586335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY R GOLDSTEIN MS, CLC, IBCLC

Provider Business Mailing Address
First Line	:	13803 BLUFF IVEY LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7921
Country	:	US
Telephone Number	:	518-420-9408
Fax Number	:

Provider Business Practice Location Address
First Line	:	13803 BLUFF IVEY LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7921
Country	:	US
Telephone Number	:	518-420-9408
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	03/25/2026

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