Provider Demographics
NPI:1336456409
Name:KONKOL, JENNIFER ANN (CPM, CLC, BSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:KONKOL
Suffix:
Gender:F
Credentials:CPM, CLC, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 ALBY ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4401
Mailing Address - Country:US
Mailing Address - Phone:618-610-4777
Mailing Address - Fax:618-462-0603
Practice Address - Street 1:3271 ROGER PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-3838
Practice Address - Country:US
Practice Address - Phone:618-610-4777
Practice Address - Fax:618-462-0603
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
10030014OtherNORTH AMERICAN REGISTRY OF MIDWIVES - CERTIFIED PROFESSIONAL MIDWIFE CERT #