Provider Demographics
NPI:1730729039
Name:HIGH COUNTRY LACTATION CARE, INC
Entity type:Organization
Organization Name:HIGH COUNTRY LACTATION CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOCCIA-KENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, IBCLC
Authorized Official - Phone:928-556-0000
Mailing Address - Street 1:401 W ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5305
Mailing Address - Country:US
Mailing Address - Phone:928-556-0000
Mailing Address - Fax:928-556-0005
Practice Address - Street 1:401 W ASPEN AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5305
Practice Address - Country:US
Practice Address - Phone:928-556-0000
Practice Address - Fax:928-556-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty