Provider Demographics
NPI:1710303177
Name:DUCKLES, JENNIFER SCESA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SCESA
Last Name:DUCKLES
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1900
Mailing Address - Country:US
Mailing Address - Phone:856-942-4305
Mailing Address - Fax:
Practice Address - Street 1:915 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1900
Practice Address - Country:US
Practice Address - Phone:856-942-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN559169163WL0100X
PA11044552163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant