Provider Demographics
NPI:1407279599
Name:JENNINGS, EMILY S (CLC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:S
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8298
Mailing Address - Country:US
Mailing Address - Phone:989-312-3071
Mailing Address - Fax:
Practice Address - Street 1:400 S UNIVERSITY AVE
Practice Address - Street 2:SUITE B, ROOM C
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3170
Practice Address - Country:US
Practice Address - Phone:989-312-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIALPP ID # 201673174N00000X
MIDONA TRAINED DOULA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula