Provider Demographics
NPI:1134983539
Name:BABCOCK, JENNIFER L (IBCLC, CHW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:IBCLC, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 S MORRICE RD
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8983
Mailing Address - Country:US
Mailing Address - Phone:517-281-2763
Mailing Address - Fax:
Practice Address - Street 1:149 E CORUNNA AVE FL 2
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1497
Practice Address - Country:US
Practice Address - Phone:989-251-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker