Provider Demographics
NPI:1245520774
Name:STEWART, JENNIFER G (IBCLC, CPM, LM)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:G
Last Name:STEWART
Suffix:
Gender:F
Credentials:IBCLC, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ANNA GRAY CIR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-9327
Mailing Address - Country:US
Mailing Address - Phone:909-575-7323
Mailing Address - Fax:888-340-7874
Practice Address - Street 1:902 N PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1600
Practice Address - Country:US
Practice Address - Phone:864-583-5831
Practice Address - Fax:888-340-7874
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
CALM325176B00000X
SCLMW-0082176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN