Healthcare Provider Details

I. General information

NPI: 1891508065
Provider Name (Legal Business Name): DEAR DOULA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 SAINT LOUIS AVE
ROCKFORD IL
61104-1521
US

IV. Provider business mailing address

206 SAINT LOUIS AVE
ROCKFORD IL
61104-1521
US

V. Phone/Fax

Practice location:
  • Phone: 701-870-0734
  • Fax:
Mailing address:
  • Phone: 701-870-0734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JENNA M FITZGERALD
Title or Position: DOULA
Credential: CD
Phone: 701-870-0734