Healthcare Provider Details

I. General information

NPI: 1295133734
Provider Name (Legal Business Name): JENNIFER CLANCY BIRTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7232 STOVER CT
ALEXANDRIA VA
22306-3512
US

IV. Provider business mailing address

7232 STOVER CT
ALEXANDRIA VA
22306-3512
US

V. Phone/Fax

Practice location:
  • Phone: 856-392-1646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN CLANCY
Title or Position: FOUNDER
Credential: M.A.
Phone: 856-392-1646