Provider Demographics
NPI:1457161788
Name:ALLEN, JENNIFER (DOULA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 W BELMONT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2193
Mailing Address - Country:US
Mailing Address - Phone:773-367-7064
Mailing Address - Fax:
Practice Address - Street 1:33 W GRAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6799
Practice Address - Country:US
Practice Address - Phone:800-325-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1225241510374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty