Provider Demographics
NPI:1497532485
Name:PRAZAK, JENNIFER (RNC-OB, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PRAZAK
Suffix:
Gender:F
Credentials:RNC-OB, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 N HOYNE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2503
Mailing Address - Country:US
Mailing Address - Phone:630-453-7651
Mailing Address - Fax:
Practice Address - Street 1:1931 W BELMONT AVE APT 3E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7199
Practice Address - Country:US
Practice Address - Phone:630-453-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-311663163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant