Provider Demographics
NPI:1346905007
Name:AUSTIN, JESSICA DANIELLE (IBCLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DANIELLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:441 MARY MCCLENDON RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-8348
Mailing Address - Country:US
Mailing Address - Phone:334-709-0761
Mailing Address - Fax:
Practice Address - Street 1:441 MARY MCCLENDON RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-8348
Practice Address - Country:US
Practice Address - Phone:334-709-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA327448101Y00000X
L-307238174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No101Y00000XBehavioral Health & Social Service ProvidersCounselor