Provider Demographics
NPI:1336441633
Name:RACKOW, JILL MARIE (CD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:RACKOW
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 SWIGART ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2728
Mailing Address - Country:US
Mailing Address - Phone:217-840-8619
Mailing Address - Fax:
Practice Address - Street 1:606 SWIGART ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2728
Practice Address - Country:US
Practice Address - Phone:217-840-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula