Provider Demographics
NPI:1356014617
Name:FOX, JESSICA R (IBCLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:FOX
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 1:1099 S MAIN ST APT 323
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4840
Mailing Address - Country:US
Mailing Address - Phone:708-368-3846
Mailing Address - Fax:
Practice Address - Street 1:1099 S MAIN ST APT 323
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4840
Practice Address - Country:US
Practice Address - Phone:708-368-3846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN