Provider Demographics
NPI:1215481106
Name:WELLS, JESSICA (IBCLC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:
Other - Last Name:ST. CLAIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:412 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2706
Mailing Address - Country:US
Mailing Address - Phone:360-624-5631
Mailing Address - Fax:
Practice Address - Street 1:412 E 29TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2706
Practice Address - Country:US
Practice Address - Phone:360-624-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-98396174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN