Healthcare Provider Details

I. General information

NPI: 1538803093
Provider Name (Legal Business Name): JENNIFER JOANN SMEJKAL IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SHERWOOD DR
ROSCOMMON MI
48653-9218
US

IV. Provider business mailing address

115 SHERWOOD DR
ROSCOMMON MI
48653-9218
US

V. Phone/Fax

Practice location:
  • Phone: 989-400-7975
  • Fax:
Mailing address:
  • Phone: 989-400-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-141873
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: