Individual
KELLY SORENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
23582 RAPALLA CT, ATHOL, ID 83801-7002
(909) 553-2113
Mailing address
23582 RAPALLA CT, ATHOL, ID 83801-7002
(909) 553-2113
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
L-110382
ID
Other
Enumeration date
12/21/2016
Last updated
12/21/2016
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