Healthcare Provider Details

I. General information

NPI: 1861380875
Provider Name (Legal Business Name): JACQUELYN EALEY CLS, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACKIE EALEY CLS. CD(DONA)

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8849 S OGLESBY AVE
CHICAGO IL
60617-3038
US

IV. Provider business mailing address

8849 S OGLESBY AVE
CHICAGO IL
60617-3038
US

V. Phone/Fax

Practice location:
  • Phone: 773-733-3384
  • Fax:
Mailing address:
  • Phone: 773-733-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: