Provider Demographics
NPI:1013794577
Name:GRIFFIN, JENNIFER L (MCD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-3150
Mailing Address - Country:US
Mailing Address - Phone:217-341-8361
Mailing Address - Fax:
Practice Address - Street 1:2263 RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3150
Practice Address - Country:US
Practice Address - Phone:217-341-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula