Provider Demographics
NPI:1801253653
Name:MCINTOSH, JENNIFER C (IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:MCINTOSH
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 1:16515 N RIMROCK RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7854
Mailing Address - Country:US
Mailing Address - Phone:208-277-7701
Mailing Address - Fax:
Practice Address - Street 1:16515 N RIMROCK RD
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7854
Practice Address - Country:US
Practice Address - Phone:208-277-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDL-62016174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN