Provider Demographics
NPI:1235765819
Name:SPEVAK BARBOSA, JESSICA (IBCLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SPEVAK BARBOSA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SPEVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:1150 DARLENE LN APT 142
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1109
Mailing Address - Country:US
Mailing Address - Phone:541-510-3573
Mailing Address - Fax:
Practice Address - Street 1:1150 DARLENE LN APT 142
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1109
Practice Address - Country:US
Practice Address - Phone:541-510-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLC-LC-10206610174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN