| Doctor Name: | MAYA RADOCCIA-KENNEN |
| NPI Number: | 1053797159 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | IBCLC |
| License Number: | |
| Business Practice Address: | 510 Main St Clarkdale, AZ - 86324 |
| Business Phone Number: | 9283013274 |
| Business Fax Number: | |
| Mailing Address: | Po Box 225, CLARKDALE |
| State: | AZ |
| Postal Code: | 863240225 |
| Phone Number: | 9283013274 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2015 |
| NPI Last Update Date: | 07/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174N00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Lactation Consultant, Non-RN |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained to provide breastfeeding assistance services to both mothers and infants. Lactation Consultants are not required to be nurses and are trained through specific courses of education. The Lactation Consultant may have additional certification through a national or international organization. |