Provider Demographics
NPI:1861380875
Name:EALEY, JACQUELYN (CLS, CD(DONA))
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:EALEY
Suffix:
Gender:F
Credentials:CLS, CD(DONA)
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:EALEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CLS CD(DONA)
Mailing Address - Street 1:8849 S OGLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3038
Mailing Address - Country:US
Mailing Address - Phone:773-733-3384
Mailing Address - Fax:
Practice Address - Street 1:8849 S OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3038
Practice Address - Country:US
Practice Address - Phone:773-733-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174N00000X
IL15535374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN