Provider Demographics
NPI:1598055774
Name:GRIECO DESMARAIS, JENNIFER SUZANNE (CPM, RM, LM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:GRIECO DESMARAIS
Suffix:
Gender:F
Credentials:CPM, RM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 WINDFALL DR.
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550
Mailing Address - Country:US
Mailing Address - Phone:949-929-7153
Mailing Address - Fax:
Practice Address - Street 1:1832 WINDFALL DR.
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550
Practice Address - Country:US
Practice Address - Phone:949-929-7153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298176B00000X
CALM298176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty