Provider Demographics
NPI:1598450991
Name:KLECKNER, JENNIFER L (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:KLECKNER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:941 KELLY LN
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-9509
Mailing Address - Country:US
Mailing Address - Phone:815-343-3623
Mailing Address - Fax:
Practice Address - Street 1:941 KELLY LN
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-9509
Practice Address - Country:US
Practice Address - Phone:815-343-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
IL041351296163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN