Healthcare Provider Details

I. General information

NPI: 1508653494
Provider Name (Legal Business Name): JADE THOMAS CD(DONA), CLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S COUNTRY FAIR DR STE 2A
CHAMPAIGN IL
61821-3637
US

IV. Provider business mailing address

1209 E SOUTH ST
CLINTON IL
61727-2336
US

V. Phone/Fax

Practice location:
  • Phone: 217-675-7019
  • Fax:
Mailing address:
  • Phone: 217-853-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: