Provider Demographics
NPI:1902607849
Name:KAHELIN, TRACEY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:KAHELIN
Suffix:
Gender:
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1335
Mailing Address - Country:US
Mailing Address - Phone:440-935-2668
Mailing Address - Fax:
Practice Address - Street 1:153 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1335
Practice Address - Country:US
Practice Address - Phone:440-935-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.391137163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant