Provider Demographics
NPI:1124750872
Name:SAGRITALO, KAITLYN (IBCLC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SAGRITALO
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 RENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3720
Mailing Address - Country:US
Mailing Address - Phone:574-855-6128
Mailing Address - Fax:
Practice Address - Street 1:14521 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-4103
Practice Address - Country:US
Practice Address - Phone:248-688-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-307725174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN