Healthcare Provider Details

I. General information

NPI: 1487069837
Provider Name (Legal Business Name): JENNIFER KOWAL IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 09/26/2020
Certification Date: 09/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 PLYMOUTH ST STE 301
MONTCLAIR NJ
07042-2677
US

IV. Provider business mailing address

33 PLYMOUTH ST STE 301
MONTCLAIR NJ
07042-2677
US

V. Phone/Fax

Practice location:
  • Phone: 973-493-2632
  • Fax: 973-658-6604
Mailing address:
  • Phone: 973-493-2632
  • Fax: 973-658-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: