Provider Demographics
NPI:1770167918
Name:HOPP, JESSICA (IBCLC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HOPP
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4228
Mailing Address - Country:US
Mailing Address - Phone:530-919-7187
Mailing Address - Fax:
Practice Address - Street 1:6228 FILBERT AVE STE 1
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4106
Practice Address - Country:US
Practice Address - Phone:916-827-5571
Practice Address - Fax:916-827-0872
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
L-302737174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-302737OtherIBCLC CERTIFICATION NUMBER
374J00000XOtherDOULA