MEDICARE: BE WELL BIRTH WELL BIRTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula	20141054740	CO

General Provider Information

NPI Number	:	1558784678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BE WELL BIRTH WELL BIRTH SERVICES

Provider Business Mailing Address
First Line	:	20210 PHOEBE GRV
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-1176
Country	:	US
Telephone Number	:	719-229-3556
Fax Number	:

Provider Business Practice Location Address
First Line	:	20210 PHOEBE GRV
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-1176
Country	:	US
Telephone Number	:	719-229-3556
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LABOR DOULA
Name	:	JENNIFER LEONARD
Credential	:	CLD
Telephone Number	:	719-233-4042

Provider Enumeration Date	:	01/24/2014
Last Update Date	:	01/24/2014

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