Provider Demographics
NPI:1033653456
Name:KIDD, CAROL (BA, IBCLC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:BA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 W TANYA TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4328
Mailing Address - Country:US
Mailing Address - Phone:602-888-1969
Mailing Address - Fax:
Practice Address - Street 1:3424 W TANYA TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-4328
Practice Address - Country:US
Practice Address - Phone:602-888-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-94970174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN