Provider Demographics
NPI:1538803093
Name:SMEJKAL, JENNIFER JOANN (IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOANN
Last Name:SMEJKAL
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-9218
Mailing Address - Country:US
Mailing Address - Phone:989-400-7975
Mailing Address - Fax:
Practice Address - Street 1:115 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-9218
Practice Address - Country:US
Practice Address - Phone:989-400-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
MIL-141873174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN