Provider Demographics
NPI:1518409705
Name:SYPOLT, JESSICA (IBCLC, RLC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:SYPOLT
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17376 TEDLER CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-2633
Mailing Address - Country:US
Mailing Address - Phone:972-979-3015
Mailing Address - Fax:
Practice Address - Street 1:17376 TEDLER CIR
Practice Address - Street 2:
Practice Address - City:ROUND HILL
Practice Address - State:VA
Practice Address - Zip Code:20141-2633
Practice Address - Country:US
Practice Address - Phone:972-979-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-05
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN