Provider Demographics
NPI:1346062338
Name:JUSTICE, JESSICA AUTUMN (RN IBCLC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:AUTUMN
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 S COLE CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4956
Mailing Address - Country:US
Mailing Address - Phone:570-326-2105
Mailing Address - Fax:
Practice Address - Street 1:2702 S COLE CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4956
Practice Address - Country:US
Practice Address - Phone:570-326-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COL-124775163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant