Provider Demographics
NPI:1508653494
Name:THOMAS, JADE (CD(DONA), CLS)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:
Credentials:CD(DONA), CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2336
Mailing Address - Country:US
Mailing Address - Phone:217-853-1136
Mailing Address - Fax:
Practice Address - Street 1:503 S COUNTRY FAIR DR STE 2A
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-3637
Practice Address - Country:US
Practice Address - Phone:217-675-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN