Provider Demographics
NPI:1316699044
Name:CONLEY, KRISTIN ANN (IBCLC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:CONLEY
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 1:2340 HARMONY PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2773
Mailing Address - Country:US
Mailing Address - Phone:303-250-0534
Mailing Address - Fax:
Practice Address - Street 1:2902 ZUNI ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3827
Practice Address - Country:US
Practice Address - Phone:303-250-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-104791174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-104791OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS