Provider Demographics
NPI:1194084707
Name:MY BABY BUMP
Entity type:Organization
Organization Name:MY BABY BUMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LEAD SONOGRAPHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOISE
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS
Authorized Official - Phone:931-980-8070
Mailing Address - Street 1:894 HIGHWAY 76 STE 104
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5396
Mailing Address - Country:US
Mailing Address - Phone:931-358-2229
Mailing Address - Fax:
Practice Address - Street 1:894 HIGHWAY 76 STE 104
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5396
Practice Address - Country:US
Practice Address - Phone:931-358-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9281225700000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty