Provider Demographics
NPI:1871065250
Name:BECK, JENNIFER SUE (IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:BECK
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 1:984 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102
Mailing Address - Country:US
Mailing Address - Phone:815-222-4596
Mailing Address - Fax:
Practice Address - Street 1:506 N ELIDA
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:IL
Practice Address - Zip Code:61088
Practice Address - Country:US
Practice Address - Phone:815-222-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-98594174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN