Provider Demographics
NPI:1760079784
Name:BEEMSTERBOER, JESSICA (IBCLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BEEMSTERBOER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 STADIUM CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5226
Mailing Address - Country:US
Mailing Address - Phone:708-899-9988
Mailing Address - Fax:
Practice Address - Street 1:2300 WASHTENAW AVE STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4500
Practice Address - Country:US
Practice Address - Phone:734-975-6534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN