Provider Demographics
NPI:1821642174
Name:HAFELE, JENNIFER (IBCLC, CLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HAFELE
Suffix:
Gender:F
Credentials:IBCLC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3030
Mailing Address - Country:US
Mailing Address - Phone:715-497-1044
Mailing Address - Fax:
Practice Address - Street 1:3402 DAVID DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3030
Practice Address - Country:US
Practice Address - Phone:715-497-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-57463174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN