Provider Demographics
NPI:1376064048
Name:LAFAVOR, JESSICA M (CD(DONA))
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:LAFAVOR
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:GRATEFUL LIFE DOULA SERVICES LLC
Mailing Address - Street 2:205 MANTORVILLE AVE. S.
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944
Mailing Address - Country:US
Mailing Address - Phone:507-271-4784
Mailing Address - Fax:
Practice Address - Street 1:205 MANTORVILLE AVE. S.
Practice Address - Street 2:GRATEFUL LIFE DOULA SERVICES LLC
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944
Practice Address - Country:US
Practice Address - Phone:507-271-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula